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Re: Afraid to get OI's
Jul 31, 2008

Hi there Dr Bob! Thanks a lot for your answer regarding OI's. Yes, all you said was extremely useful for my decision. Talked to my Hiv doc and I finally made the decision of keep working at the emergency room. It's something I really like and that satisfies me as a phisician and will not give it up because HIV. Surely, I'll be in a higher risk than the rest of people but will take my precautions and hope that everything will be just fine. Yes tuberculosis is very common here, so the chances of being with patients with it is really high. But I'll cross my fingers. Im still a person with 'very good vibrations'. Don't know if you are going to Mexico for the world conference, so I would like to wish a very good work there, if you go. Take care and all the best. Once again thanks a lot and greetings from Lisbon (Portugal)

Response from Dr. Frascino

Hi Lisbon-Doc,

You're very welcome. You've made the same decision I would have made if I were in your position.

Yes, I'm going to Mexico City for the World AIDS Conference. In fact, my flight leaves at 6:15 AM. So it's time for me to find my passport and Mexican pesos and start packing.

Be well. Stay well.

Dr. Bob

Afraid to get OI's at work Jul 30, 2008

Hi Doctor Frascino! I'm a poz doctor recently diagnosed and about to start treatment (am waiting for a resistance test results) from EU country. Am especialized in internal medicine and therefore I have to work a lot at the emergency room as a part of my job. Am afraid of getting OI's there since tuberculosis is a common place in my country and I just don't want to work with facial masks all the time (my colleagues and nurses will be suspicious about it and I just don't want them to know my poz status at work). I'm taking all the precautions like guide lined vaccunas for HIV people, washing hands, etc. What I want is a opinion from you as a colleague (don't feel comfortable to talk about it with my colleagues). Should I give up of this part of my job? I just love to work at the emergency room and that it'll be a very sad decision for me. Do you know many cases like mine? What do those doctors generally do? Your answer will be very appreciated. All the best for you and continue this great job. Take care

Response from Dr. Frascino

Hi,

Sorry to hear about your recent diagnosis. Your risk of opportunistic infections (OIs) would be related to your degree of immune compromise. If your absolute CD4 count falls to 200 (CD4% of 14%), your risk of Pneumocystis carinii pneumonia (PCP) would significantly increase. Other common OIs, such as CMV, Toxo, MAC, etc., become more of a threat as the CD4 count falls even further.

Tuberculosis, like hepatitis, is a somewhat different situation, because risk of infection is not related to CD4 count. Everyone is susceptible to these pathogens. The problem is that if an HIVer contracts these illnesses, he can be more difficult to treat and also can see his HIV flare.

I would suggest you level with your HIV specialist. He should be able to advise you regarding your OI risk based on your immune parameters. As for the diseases, like TB and hepatitis, that decision would be yours to make. Yes, there would be some risk, particularly if you treat a fair amount of TB in your area. Do I know other HIV-poz physicians who work in emergency rooms? Yes, I do. They too understand the risks and take precautions as necessary.

Good luck! I'm here if you need me, OK?

Dr. Bob



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