Dear Doctor, I was diagnosed with HIV last Aug., had PCP when I was diagnosed...in fact, I wouldn't even have tested again if I hadn't been so miserably sick. My very first blood tests were VL 750,000 and CD4 36. Today, my VL is 613 and my CD4 is over 100...finally. I was devastated when I tested positive, even more so when the doctor said I had probably been infected a lot longer than I thought (although test of Feb. 2000 was neg). I alternate between periods of deep depression and morbidity and periods of wanting to do something about this to help other suffering with this disease. I take Paxil 30mg QD but the therapist I have been seeing obviously got her Ph.D. out of a box of cracker jacks. Since I have a fiar amount of knowledge about the disease progression of AIDS, I live in a low-level constant terror...cryptosporidium, toxoplasmosis, cytomegalovirus...the whole nine yards. How can I overcome these things so that I can continue in pursuit of my degree, a Master's in Psychology, and make some lemonade out of the lemons (I was infected by my husband, who KNEW he was positivex 4 yrs. and did not tell me or anyone else). Also, what can the typical patient with AIDS realistically expect? My numbers are constantly improving and, although I do have an active MAC infection (biaxin and ethambutol), I feel fine and am finally gaining some weight. Do ALL people who have AIDS have to face these terrible OI's? Thanks so much for your help and support. Hopefully I can get myself together and pass your help along! Pam

First of all tell your therapist very directly and clearly what you told me about why you are not happy with the treatment you are receiving. If he or she becomes defensive and/or if talking openly about your not feeling that the therapy is helpful does not improve the treatment then fire this therapist and find another one. Shop around for a person who has alot of experience in working with people living with AIDS and with whom you feel the right fit.

To find a well qualified person ask your primary care doctor if he or she can suggest someone and explain the kind of person you are looking to work with. Also call the local AIDS service organization and ask them for referrals. Have several initial consulations so you can compare the people and how you feel about begining to work with them.

Now I really do not understand why you feel that it is inevitable that you are going to get opportunistic infections, especially today when there are such good prophylaxis for so many of the opportunistic illnessnes and good antiretroviral therapy also helps increase the odds of never coming down with any of the AIDS related illnesses. I have a confirmed exposure to HIV for almost 30 years and have never had any AIDS related illnesses. Prior to beginning combination antiretroviral therapy my viral loads were almost a million, but have been virtually undetectable for many years. I have literally never lost one day of work due to an AIDS related medical condition in my entire life.

But to insure that you are receiving the very best medical care you have to make sure of two things. First is that your doctor is really an expert in HIV care who is on the front lines of treating people with AIDS and treats a large number of patients who have HIV and AIDS. You do not want to be his or her learning curve. It is essential that you have a doctor with whom you can work as a partner in your medical care.

Then you must continue to pursue your dreams of graduate school and a new career. Plan for a future and do everything in your power to move towards it. Never deny that you have a life threatening illnesss. Use that information to inform how you maximize the quality of your life.

Best of luck.

Michael Shernoff, MSW