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The question from Peru on 12-13-01
Dec 20, 2011

Dr. Young, That question irritated me a little because his implication and insinuation was that should he have an AIDS diagnosis that "it's a wrap" if you will, that one foot will automatically be in the grave with the second soon to follow which seems to be the common mis-conception. Isn't it actually an untreated OI that will kill you?

I have AIDS, that is, the CDC definition of AIDS which I understand from a number of questions I read posed to the late Dr. Frascino that the diagnosis stays regardless of CD4 count improvement anyway. I was hospitalized in 2008 for a month with PCP Pneumonia, Diseminated Histoplasmois and MAC. At the time my CD4 was 6 and my VRL was 650K plus. My last test this month CD4 208 CD4% 10 (which I know CDC defines <14 as AIDS. VRL was <20 (was for the last several tests <48) Liver function/kidney function etc all within normal range. I am (have been since my discharge) on Atripla, Itraconazole, Dapsone and Gabapentin. I also take a multi-vitamin and take Vitamin D and C supplements. I was on Clarithamyacin and Ethambutol but was taken off of those when my CD4 hit over 100. My point is (and why the question's implication irritated me a little) that about 2 months after my discharge I went back to work full-time and have been working full-time plus ever since. I am a 51 year old gay male and can still , depsite having AIDS, dance and think circles around some of my negative co-workers half my age. Am I an exception Dr. Young? Or am I missing something?

Thanks,

J in Atlanta

Response from Dr. Young

Hello and thanks for posting.

I'm not sure I understand the source of your irritation, but sorry that you might have taken my reply that way.

You're correct, an untreated opportunistic infection can indeed kill you. It was my interpretation from the writer that he did not have an OI, nor had a medical history of AIDS. Rather that he was concerned that even with adherence to a good treatment that regression to AIDS and OIs was inevitable.

As for your situation, you did have very serious immune dysfunction at time of diagnosis of AIDS, with a very low CD4 count and three different OIs. It seems as though you received excellent care and have responded to treatment very well. Your return to work, dance, thinking and life is of course a cause of celebration - though not always is the case so rapid for others in your situation. FWIW, once someone has an AIDS diagnosis, medically-speaking, we keep that diagnosis on the books, even after immune recovery. This is an issue of medical record keeping, more than necessarily a measure of immediate (or future) disease risks.

So, your case might perhaps be a little exceptional, but not atypical. Many patients with advanced OIs do recover their health completely, some take longer than your quick return to health.

I hope that helps and wish you a healthy and happy holiday season. BY



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