|Is my doctor handling this correctly?
Mar 11, 2002
I have been +ve for at least 17 years and on various meds for the past 12 years. I've done VERY well. For the past couple of years I've been on Sustiva, Ziagen and Epivir and cell counts have been around 700, viral loads around 400. For the past year I've been very tired. Couldn't get through the day without a 2 or 3 hour nap. My doctor was unconcerned so I finally went to a new doc for a second opinion. He thought I should go off of meds for a while and, without researching the risks, I agreed. The treatment break worked on my fatique and for the first month I felt great. Then the other shoe dropped. I developed a fever and severe muscle aches. I've been sick for three weeks now, flat on my back in bed. My new doctor is not concerned...hasn't even suggested a physical or blood work. I've asked to be put back on HAART but he wants to wait until he gets a sensitivity test back he took a few weeks ago (before I got sick). Do you think I should go back on HAART? Should I wait for the sensitiviy test or just start back on my old regimen? I'd rather be tired than feverish! Also, don't you think my doctor should have told me that this could happen? Thanks for your time doctor. I've learned a tremendous amount from you by reading your responses to others but never thought I'd need to write to you myself!
Response from Dr. Henry
I've been in that situation with a number of patients. Perhaps 5% or more of patients develop symptoms like the acute retroviral syndrome when they stop fairly effective treatment. Many of those cases will get huge increase in the viral load and a precipitous drop in T-cells (more likely if pre-treatment viral level was high and CD4 count low). Many other conditions can contribute to fatigue (low thyroid, low testosterone, anemia, other infections, etc). Usually it is a good idea to get a viral load/C4 count within a month or so of stopping meds to see where the patient is at (monitoring when stopping meds can be as important as monitoring when starting meds). KH
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