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worried for my mother ,your early attention will highly be appreciated
Jan 29, 2011

Hi there Dr Bob,

My mom who is 55 years old recently got diagonised with HIV+. She lives in India and doctors are not giving her any medications as of now. She has symptoms like on and off fever (even upto 40 degrees F), cough, loss of appetite, very bad mouth taste, weight loss (lost about 20lbs in 8 months)and feels very weak all the time.

This is how the reports looked. As of 19th Nov 2010-- HIV-1 Viral load by Cobas Taqman - 1830000 % CD3+/CD45+ (T-CELLS) 80.8 ABSOLUTE CD3+ LYMPHOCYTE COUNT 1285 %CD3+/CD4+ (T-HELPER CELLS) 12.3 ABSOLUTE CD4 LYMPHOCYTE COUNT 196 %CD3+/CD8+ (T-SUPPRESSOR CELLS) 66.0 ABSOLUTE CD8+ LYMPHOCYTE COUNT 1050 CD4/CD8 RATIO 0.19

As of 5th Jan 2011-- T Lymphs % of Lymphs (CD3+/CD45+) 81 T Lymphs (CD3+) Abs Cnt 2509 T Helper % of Lymphs (CD3+/CD4+/CD45+) 10 Lo T Helper Lymphs (CD3+/CD4+) Abs Cnt 325 Lo Lymphocyte (CD45+) Abs Cnt 3117

Can you please compare these two results and tell me if its showing some improvement in CD4 or not. I am really worried about her and not able to understand why doctors in India are not giving her the ART therapy. Looking at these reports what would be your suggestion? Can you please tell me if her CD4 level and viral load is very low/ moderate/ high. I am really concerned for her and want to get her into the right treatment. What can we do to get rid of her fever, it really makes her body ache. I have so many questions as I am really concerened for my mother.

Thank you kindly Ellonika

Response from Dr. Frascino

Hello,

Based on the results from November 19, 2010, your mom has qualified for an AIDS diagnosis, as her CD4% is 12.3% and absolute CD4 count is 196. She has significant immune deficiency and a high HIV plasma viral load (183,100). Antiretroviral therapy as well as prophylaxis against pneumocystis carinii pneumonia (PCP) would definitely be warranted.

The January 5, 2011 results continue to show profound depression of CD4% (10%), but an increase in absolute CD4 count to 325. Because the CD4% remains very low, the rise in absolute CD4 would not alter the need for antiretroviral therapy.

As for why the physicians in India have not begun ART, perhaps they are evaluating and treating an opportunistic infection first or are following now outdated guidelines that recommend ART only when the CD4 count is below 200-250. In my opinion ART is definitely warranted and should be started without further delay.

Her fever may be due to an opportunistic infection or malignancy. A thorough workup in light of her significant immunodeficiency is warranted.

Your concerns are justified. Perhaps you could contact her physicians in India to find out additional information and ascertain their plan for further evaluation and treatment.

Dr. Bob



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