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Follow-up to pneumonia question and 3-4 days of HIV meds
Sep 24, 2009

Dear Dr. Young,

I have a follow-up to a question I asked and you answered. I don't want to be greedy as I know you get many questions. I just had quick follow-up.

You said the strep pneumonia I got was not due to my CD-4 reading of 171 while I was sick in the hospital...rather my CD-4 of 171 was due to being sick with strep pneumonia and the 171 figure was artificially low due to being sick because it rebounded to above 1,000 after getting better.

Some have said I wouldn't have gotten strep pneumonia if I were HIV neg. They said a healthy 33 year-old just would not get it. They said the HIV caused me to get sick with it--even though I've read where several Marines got it who were HIV neg and many of them ended up very sick. I was also a smoker at the time and had been to a bon-fire where I breathed a lot of smoke..all right before getting sick.

So, I'm confused. This goes along with another question I have. My HIV doc says if I get a cold/flu, I should not worry about it, and if I do feel I need to see a doctor I should see my regular doc.

What do most HIV docs say about this? My regular doc doesn't know my HIV status. I would tell him if need be; however, I don't think he'd know much about HIV to determine proper care. Plus, I haven't seen him since learning my HIV status.

Should HIV docs be the ones to treat things like cold and flu? I guess I'm still of the thinking that any illness has the possibility of killing me. I'm trying to get over being so scared of getting a cold/flu as I know it is going to happen at some point. To remind you-- I'm not on meds yet with CD-4 around 800. Should HIV patients really just treat a cold or flu as they would have if HIV neg--just monitor it and go to doc if something seems bad??

Response from Dr. Young

Hi and thanks for your reply.

Probably a couple of points to clarify. First off, Strep pneumo was a serious cause of pneumonia long before there was HIV, and will continue to be a pathogen in HIV+ and HIV-er's. (And yes, this is yet another example of why tobacco is a bad thing). Now, that said, HIVers are also at greater risk of getting Strep pneumonias, so I wouldn't discount that relationship.

Rather, your very low CD4 count tested during the pneumonia was likely influenced by the acute illness, rather than representing a true baseline. Indeed, just as alluded to above, if you test the CD4 of a HIV- person during a pneumonia, I'd wager that it too would be low.

I'm also in general agreement with your doctor-- HIV+ persons are at greater risk for certain unusual conditions, but not every infection (like the common cold). Nevertheless, it's dishonest, if just a plain bad idea to not let your primary care doctor know about your status-- this one piece of medical information can certainly influence the way that he would assess your medical needs and risks.

The flu is a slightly different story-- this year in particular- first off, getting the seasonal and H1N1 vaccinations are a really good idea. I'm recommending both to my patients and will receive both myself (I've already had my seasonal flu shot). Should you develop serious flu symptoms, like high fever, body aches or cough, you should let your doctor know quickly. There are medicines that can minimize the severity or duration of true influenza symptoms.

So, in the end, with a CD4 count of 800 and otherwise feeling well, I'd think that your short-term health risks should be minimal; I'd likely handle a routine cold just as I would in someone who's HIV negative.

Hope this helps,

BY



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