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Should I feel frustrated?

Jun 2, 2013

Hi Doc,

I've been be going to the same infectious disease specialist since I was diagnosed in 2006. My CD4 is over 700, CD4% is 34, and vl is undetectable (it always is) on Atripla. I'm starting to get annoyed, though, because I'm also concerned about other things like my high cholesterol, tracking my blood pressure (which is normal thus far), and vitamin D levels. In other words, things other than HIV. Unfortunately she doesn't share my interest and sometimes I wonder how much she actually knows outside of her specialization. When I ask her about the significance of my cholesterol numbers, for example, because they are always high regardless of what I do, she responds by asking if I have a primary care provider, and I'm like ummm....yeah. It's you. My six-month visits last about 60 seconds during which time she tells me that viral load is undetectable and CD4 counts are normal and then the same routine about listening to my breathing and whatever. She's not really doing anything I couldn't have done myself and I don't really see a point in going to appointments anymore. I'm thinking of just going once a year. I told the nurse this once and the nurse said, well, if there was something wrong we would tell you. I think she's a good infectious disease specialist, but I am also worried about other things that she never addresses. I don't want to change doctors after so long, but I'm getting upset that she doesn't address any other of my health concerns even when I bring them up. What should I do?

Response from Dr. Young

Hello and thanks for posting.

Your questions raises one of the central issues in HIV care today-- namely the topics of long-term, healthy aging with HIV in the era of successful antiretroviral therapy. Indeed, there's now much more to care and monitoring than just CD4s and viral loads.

There is a shifting paradigm as to the new themes- cardiovascular , liver, kidney, bone health to name a few, and many HIV/AIDS specialists are less keen to treat or as up to date on these issues. As such some HIV specialists are (re)learning the best practices on these general health issues, while in other programs, HIV patients are linked to savvy primary care providers.

In your situation, if you have a good relationship with your doctor, why not ask about whether she is comfortable managing these primary care issues or should you also periodically consult with a general medicine (internal or family medicine) care provider.

I hope that this is helpful, BY


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