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Lymphoma and HIV
Jun 30, 2006

I have been diagnosed with HIV CD4 255 VL 145,000 within the last 6 months. I think I may have contracted it 5 years ago. I am waiting for my insurance to cover medical expenses. I was diagnosed before obtaining insurance, it is considered a pre-existing condition. So I have been getting free medication (Sustiva/Truvada) through ADAP act, but I can't go to the doctor yet to see if they are working. Anyway, I have been getting frequent nosebleeds for years, but they seem to be getting more frequent (at least 4 per week.). I used to use cocaine, but haven't in about 5 years. I also used to fight, and never had a broken nose, but it could have been fractured.

Anyway, are frequent nosebleeds a sign of lymphoma (I also have swollen lymph nodes)? Could it be caused by my previous lifestyle, even though I haven't done those things in years?

The reason I ask, is because if there is a serious emergency associated with these nosebleeds, I will try to find a way to see a doctor immediately (borrow money from family) so that I can be tested for cancer or tumors. If you don't think it is an emergency, I will wait until my insurance kicks in. Please advise. Thanks.

Response from Dr. Frascino

Hello,

First off, I'm sorry to hear about your recent HIV diagnosis and that you've been caught in the limbo of "pre-existing condition!" The Sustiva/Truvada regimen you are getting through ADAP is usually an excellent first-line HAART regimen. You didn't mention how long you have to wait for your new insurance benefits to kick in. Personally I feel all HIV-positive folks should be under the close supervision of an HIV specialist, particularly if they are taking HAART. I'd suggest you contact your local AIDS service organization to see if there are any local, state or federal programs you would be eligible for while waiting for your insurance benefits to begin. You might be able to use these services and then switch over to the specialist of your choice once benefits are in place.

Regarding nosebleeds, there are many potential causes, including the ones you mention prior use of cocaine, prior trauma, etc. I see no reason to immediately jump to lymphoma as a potential cause. Do you need to be seen emergently because of the nosebleeds? That would depend on their severity, frequency, and duration. If they are fairly easily controlled, you can wait. However, if you can't get the bleeding to stop (try putting your head back, applying pressure and ice), then you'll need medical attention urgently.

Good luck! Hopefully with the help of a competent and compassionate HIV specialist and HAART, your CD4 count and general health will both significantly improve!

I'm here if you need me, OK?

Dr. Bob



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