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Hiv and toxo
Oct 2, 2008

Hello dear Doctor!

I was diagnosed with HIV in August last year. Unfortunately, I didn't start with HAART then.

I got toxo in February this year and till now it is there. Its decreasing slowly thanks to medicines.

I have had epileptical attacks after starting with toxo treatment.

Currently I have virus load of about only 150 from 60,000 in february and Tcells are about 300 from 60 in February when I got toxo.

I'm currently taking Sulfadiazine 8 pills per day, Daraprim 2 pills, Atripla 1 pill per day, Keppra 1 pill per day, Leukovorin 3 times a week, Fluconazole 2 times per week, Vit. B complex 3 times per day.

Is my condition AIDS? Or its HIV? And where is the line between these two?

What could you advise me for improving my liver values and for feeling less tired?

How long do I have to take this whole cocktail?

I know it's all my fault, of course, but what is advisable in this situation?

Thank you very much for your kind help and replying all people, who need the answers.

Response from Dr. Frascino

Hello,

1. Yes, you have AIDS, because you are HIV positive and have an AIDS-defining opportunistic infection, toxoplasmosis. As for the difference between HIV and AIDS, see below.

2. Fatigue in the setting of AIDS is extremely common. There are many potential underlying and contributing causes. I would suggest you review the chapters in the Fatigue and Anemia forum's archives entitled "Diagnosis of Fatigue" and "Treatment of Fatigue." You should then discuss your fatigue complaints with your HIV doctor who will perform a complete evaluation and suggest therapeutic options based on the underlying pathology (causes).

3. You'll need your HIV and secondary prophylaxis for toxoplasmosis cocktails for life. I'll reprint some information below from the archives that discusses toxoplasmosis.

4. Work extremely closely with your HIV specialist. Clean up your act if you use party drugs (IV or oral), avoid excessive alcohol intake, adhere strictly to your medication regimen and, oh, did I mention work extremely closely with your HIV specialist???

Good luck. I'm here if you need me.

Dr. Bob

Toxoplasmosis

July 23, 2007

What Is Toxoplasmosis?

Toxoplasmosis (toxo) is an infection caused by the single-celled parasite toxoplasma gondii. A parasite lives inside another living organism (the host) and takes all of its nutrients from the host.

The toxo parasite is very common in cat feces, raw vegetables, and the soil. It is also common in raw meat, especially pork, lamb, or deer meat. It can get into your body when you breathe in dust. Up to 50% of the population is infected with toxo. A healthy immune system will keep toxo from causing any disease. It does not seem to spread from person to person.

The most common illness caused by toxo is an infection of the brain (encephalitis). Toxo can also infect other parts of the body. Toxo can lead to coma and death. The risk of toxo is highest when your CD4 cell (T-cell) counts are below 100.

The first signs of toxo include fever, confusion, headache, disorientation, personality changes, tremor, and seizures. Toxo is usually diagnosed by testing for antibodies to Toxoplasma gondii. Pregnant women who are exposed to toxo may pass it to their newborn child.

The toxo antibody test shows whether you have been exposed to toxo. A positive test does not mean that you have toxo encephalitis. However, a negative antibody test means that you are not infected with toxo.

Brain scans by computerized tomography (CT scan) or magnetic resonance imaging (MRI scan) are also used to diagnose toxo. A CT scan for toxo can look very similar to scans for other opportunistic infections. An MRI scan is more sensitive and can make it easier to diagnose toxo.

How Is Toxo Treated?

Toxo is treated with a combination of pyrimethamine (Daraprim®) and sulfadiazine. Both drugs can cross the blood-brain barrier.

The toxoplasma gondii parasites needs vitamin B to live. Pyrimethamine stops toxo from getting vitamin B. Sulfadiazine prevents toxo from using it. The normal dosage of these drugs is 50 to 75 mg of pyrimethamine with 2 to 4 grams per day of sulfadiazine.

These drugs both interfere with vitamin B and can cause anemia. People with toxo usually take leucovorin, a form of folic acid (a B vitamin), to prevent anemia.

This combination of drugs is very effective against toxo. Over 80% of people show improvement within 2 to 3 weeks.

Toxo usually comes back after the first episode. People who have had toxo should keep taking the anti-toxo drugs at a lower, maintenance dose.

How Do I Choose a Treatment for Toxo?

If you are diagnosed with toxo, your health care provider will probably prescribe pyrimethamine and sulfadiazine. This combination can cause a drop in white blood cells, and kidney problems.

Also, sulfadiazine is a sulfa drug. Almost half the people who take it have an allergic reaction. This usually is a skin rash, and sometimes a fever.

Allergic reactions can be overcome using a desensitization procedure. Patients start with a very small amount of the drug. They get increasing amounts until they can tolerate the full dose.

People who cannot tolerate sulfa drugs can use clindamycin (Cleocin®) instead of sulfadiazine in the combination.

Can Toxo Be Prevented?

The best way to prevent toxo is to take strong antiretroviral medications (ARVs). You can be tested to see if you have been exposed to toxo. If not, you can reduce your risk of infection by not eating undercooked meat or fish, and by wearing gloves and a face mask and washing thoroughly if you clean a cat box.

If you have less than 100 CD4 cells, you should take medication to prevent toxo. People with less than 200 CD4 cells usually take Bactrim or Septra (see Fact Sheet 535) to prevent pneumocystis pneumonia (PCP). These drugs also protect you against toxo. See Fact Sheet 515 for more information on PCP. If you can't tolerate Bactrim, your health care provider can use other drugs.

The Bottom Line

Toxoplasmosis is a serious opportunistic infection. If you have not been exposed, you can reduce your risk of exposure by not eating undercooked meat or fish, and taking extra precautions if you clean a cat box.

You can take strong ARVs to keep your CD4 cell count up. This should prevent toxoplasmosis from causing health problems. If your CD4 cell count falls below 100, talk with your health care provider about taking drugs to prevent toxo.

If you develop headaches, disorientation, seizures, or other possible signs of toxo, see your health care provider immediately. With early diagnosis and treatment, toxo can be treated effectively.

If you do develop toxo, you should continue to take the anti-toxo drugs to prevent another episode.

This article was provided by AIDS InfoNet.

AIDS diagnosis (HIV VERSUS AIDS DIAGNOSIS DEFINITION) Mar 12, 2008

12 months ago I was diagnosed with AIDS as a result of an NHL diagnosis. My CD4 was 40 and VL was 750,000. After 12 mos, my CD4 is 274, VL is <40 (new testing has triggered and no longer undetectable) I'm on Atripla and take 100-200mg of CQ10 daily. I've also beat the NHL for now too. Is this a good/normal response rate on the CD4 side? Am I still considered to have an AIDS diagnosis? Does one ever go from AIDS to HIV? How high can I expect my CD4 to go?

Response from Dr. Frascino

Hello,

Congratulations on your improved health status. Regarding the AIDS diagnosis, that remains even if your CD4 count rises above the 200 mark. (See below.) As far as how much immune reconstitution (rise in CD4 count) you can expect on effective antiretroviral therapy, the answer is no one knows. There are far too many confounding variables to predict. These include variables related to the virus (viral strain, viral resistance, etc.) and variables related to the host (genetic susceptibility to certain viruses, immune integrity, concurrent opportunistic infections or malignancies, adherence to antiretroviral regimen, etc.). The important treatment goal is to keep your HIV plasma viral load suppressed to undetectable levels with antiretroviral therapy. This allows the greatest opportunity for immune reconstitution (rise in CD4 cells). At this point I believe you have just cause to be optimistic!

Good luck.

Dr. Bob

HIV vs AIDS??? (DEFINITION HIV VERSUS AIDS) Oct 27, 2007

BIG question. I have been getting conflicting info on this. What is the difference between HIV and AIDS? I thought (think) there is a huge difference between the two.

Response from Dr. Frascino

Hello,

No, actually there is not a huge difference. Everyone with AIDS (Acquire Immune Deficiency Syndrome) is HIV positive (Human Immunodeficiency Virus positive). AIDS is diagnosed when an HIV-positive person's immune system deteriorates to a specific point (CD4 count of 200 or CD4% of 14%) or when he/she acquires certain opportunistic infections or malignancies. I've addressed this topic numerous times before. (Check the archives!) I'll reprint some basic information from the archives below.

Dr. Bob

FULL BLOWN AIDS/please answer Jul 17, 2007

what does full blown aids mean?Is there a number that states that.I have 47 tcell and 713,000 copies of hiv virus in my body.Is that considered full blown???please answer.thanks

Response from Dr. Frascino

Hi,

HIV disease is termed AIDS when the immune system has deteriorated to a specific point. The definition of that specific point was made by the CDC for surveillance purposes (so that the number of cases could be determined). At the time the definition was created, HIV disease itself was not a "reportable" condition. Consequently we had difficulty tracking the epidemic or how quickly it was spreading. The CDC then came up with the definition of AIDS and made it a reportable condition. Cases were then reported to the CDC and counted for epidemiological purposes. Since then, new laws have been passed and now HIV alone is also a reportable condition.

An AIDS diagnosis is made if the CD4 count falls below 200 or if the CD4% is less than 14%. Also, if an HIV-positive person develops certain specific "opportunistic infections or malignancies," the diagnosis of AIDS is also confirmed. This list includes Pneumocystis pneumonia, Kaposi's sarcoma and cytomegalovirus, among others. You would have AIDS because your CD4 count is less than 200.

Finally, I should mention we don't use the term "full blown AIDS" anymore, mainly because there is no such thing as "partially blown AIDS". I'll reprint some information from the archives below.

Good luck.

Dr. Bob

t-cell count determines hiv or aids diagnosis? Jul 21, 2006

I remember my doctor at the time told me if my t-cell count dropped below 200, I would be considered to have Aids, but until then I am HIV+. Is this true? My t-cell count has dropped as low as 48, but is currently over 300. Can a person go from Hiv+ to having Aids to being considered Hiv+ again? I find people, being the public are more accepting of an hiv diagnosis rather than an aids diagnosis.

I know it's a silly question, but one I have thought about for some time now.

Thank you

Response from Dr. Frascino

Hi,

I'll repost below a question and response from the archives that addresses this concern. In brief, once a diagnosis of AIDS has been made, it is not rescinded, even if the CD4 count rebounds or the AIDS-defining opportunistic infection is completely cleared. I should also mention we no longer use the terminology "full-blown AIDS", as there is not such thing as "partially blown AIDS".

Your question is not silly. That 25 years into the pandemic "the public is more accepting of an HIV diagnosis than and AIDS diagnosis" is what's really silly! It shows we still have a long way to go in educating John Q. Public about HIV/AIDS. Unfortunately that education process is made all the more difficult by our current administration's backwards policy on sex education and HIV prevention together with the Republicans in Congress bowing to pressure from religious extremists. Let's hope this situation will be at least partially resolved with the upcoming mid-term elections.

Dr. Bob

AIDS OR NOT, THATS THE QUESTION Jun 12, 2005

Dr. Bob

On 5/24/05 the posted question about AIDS classification leaves me puzzled. In 1997 ZI was diagnosed with AIDS. My cd4 was 45 and I had several opportunistic infections. At that time I was given an full blown AIDS diagnosis. Four years later my cd4 was over 600, my viral load undetectable and my diagnosis was changed to HIV+. At that time my doctor was one of the tops in the field of AIDS research and treatment. I queried him about the change in diagnosis and he said CDC guideline had changed. Your answer on 5/24/05 leaves me wondering, who is right, who is wrong, and why the difference?

William

Response from Dr. Frascino

Hi William,

The CDC has not changed their HIV/AIDS diagnosis/classification criteria. So I guess that makes me right, him wrong and overall really not much difference as I explained in the response I previously posted. (Reprinted below.)

Dr. Bob

AIDS classification question Posted: May 24, 2005

Hi Dr. Bob,

I wrote to you regarding a question in the "Am I Infected?" forum.. and I'm not sure if this is the right place for my question -- but I always take consolation in the manner that you interact with people, so I'm hoping that you'd be able to answer this question -- which, arguably, could be placed elsewhere.

My friend's CD4 count, sadly, is in the high 90s. It's my understanding that this classifies him as having AIDS (I think the number is 200?) I believe he's been HIV+ for between 3-5 years. Is it possible, at this lowered state, that he would be able to increase this count/reduce the VL to a level that would not be considered AIDS? (I'm sorry for the crude phrasing of this question; but I'm not as educated in this topic as I'd like to be) It breaks my heart that I can't help him more -- his paticular strain has become resistant to his meds and he is going to start a sort of "trial" medication in the next week or so, which hopefully will help.

I guess my question is: is there a chance that with medication, lots of care and support, that he could recover from the low CD4/VL count? It's times like this I wish I had an M.D., too, and could do something medically instead of just emotionally. This message is quite somber, for which I apologize -- but this is my first friend who is HIV+, it's tough to be strong when I see him not doing so well -- and I just want to be there for him in any way possible.

Any advice or insight you have (despite perhaps the incorrect forum classification) would truly be appreciated.

Stay well, Dr. Bob. You're an inspiration.

-- TPF

Dr. Bob's response:

Hello TPF,

Anyone with either an AIDS indicator condition or a CD4 cell count of less than 200 has a diagnosis of full blown AIDS. However, the relevance of this diagnosis is more historical and epidemiological than clinical. HIV disease is a spectrum that goes from mild, asymptomatic disease to severe, symptomatic disease. There are folks with a full-blown AIDS diagnosis, who at the present time are feeling quite well, and likewise, there are people who do not "qualify" for the AIDS diagnosis, who are very symptomatic and ill. The CDC classification of full blown AIDS is used as a criterion for tracking the epidemic and allocating federal funds. Reporting requirements for HIV infection (not full blown AIDS) vary from state to state. However all cases of AIDS must, by law, be reported to the health department. Next, is there a chance that with the proper treatment your friend could significantly increase his CD4 count (above 200) and reduce his viral load to undetectable? Yes! If his trial medications can suppress HIV viral replication, his CD4 count will rebound. Working closely with a competent and compassionate HIV specialist is crucial. Sometimes getting a second opinion form another HIV specialist can be helpful, if things are not going well.

If your friend's CD4 count does increase above 200, will he still have a full-blown AIDS diagnosis? Yes, once this diagnosis of AIDS is made, it is not negated by subsequent developments, even if treatment produces a remarkable degree of immune reconstitution. However, do remember it's your friend's health and immune status that are important, not a "diagnosis" made primarily for surveillance purposes.

Finally, I should point out: don't wish to be an M.D. to help your friend. Chances are he'll have more than enough doctors involved in his care. What most HIV folks need are friends. A true friend is often more potent, soothing and healing than any medical intervention.

Good luck to both you and your friend.

Dr. Bob



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