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Chronic HBV, AIDS and colorectal cancers
Apr 27, 2011

Hi Dr Frascino, I was tested positive for AIDS nearly 20 years ago. At that time my CD4 count was 7 and the viral load was uncountable at that point. I had had no symptoms prior, I found out when I was hospitalized with pneumonia. Since that time I have been on just about every medication out for my diagnosis as my body does not like them and side affects are too much to handle. I recently took a med "holiday" and my physician was aware of it. I now find out that I also have chronic Heb b during this "break" because I broke out in what appeared to be chickenpox or measles, long story short I have both. About 5 years ago they said I have a "fatty" liver but nothing has been done about it. My CD4 count had NEVER gone over 200 in the 20 years being positive but just before my break one test showed 205 then the next was 200, needless to say its back to 145 and vl >380000... so back on the meds. I have also been experiencing squamous cell carcinoma/cancer of the rectal canal which has been a battle going in quarterly and having it burned out, cut out, etc.. I am going in for my 17th surgery in the next 2 weeks. my question to you is with all the meds I'v been on, the history of the cancers, now knowing about the chronic hep b, should I now push my md's to check my liver? my ALT/AST was elevated that is why they re-did the hbsag, etc and then did the viral DNA its at 48,000 currently and I am back on my meds.

I'm just really concerned that things keep getting missed, etc..

Suggestions? They have told me for years, it looked like I had hepatitis b but my body fought it off, etc.. I found records of this dating back to 2000 and the very first time that anything was said to me or it was a question was from 2006 eventhough there were tests from several years prior showing this.. just not sure what to do, I feel like my health overall is not doing well and I think I may not be getting the best responses from my md's who treat me. I currently have a GP, an HIV meds MD, my colorectal surgeon and a GI doctor and I don't think any of them talk to one another.

Response from Dr. Frascino

Hi,

With your impressive medical history and current list of active problems, I would advise you work closely with an HIV physician specialist if at all possible. The HIV specialist should be the quarterback of your health care team, coordinating your care and synthesizing all the information from your other physicians (colorectal surgeon, etc.). Your current situation is too complex for most GPs.

Regarding your liver, liver function tests should be part of your routine clinical monitoring (every three months).

I would strongly advise against antiretroviral drug holidays. Clinical trials have shown they are particularly dangerous in folks like you with a history of having an extremely low CD4 nadir (CD4 of 7) and sky-high RNA/PCR viral loads.

If you have difficulty finding an HIV specialist physician in your area, consult the American Academy of HIV Medicine Web site (www.aahivm.org).

I'm here if you need me, OK?

Good luck.

Dr. Bob



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