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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Jun 27, 2007

Dear Docs,

Thanks again, again.for all the great work here!!

I decided to start meds in May 11th of this year with a VL 30,000 cd4% 362 and cd4% 15 (Sustiva 600mg and Epzicom 600mg) once a day. When I started meds I was sick with the flu and had a small fever 99-100. My doc said it was ok to start anyway. My flu seemed to clear up after about 3 days and my fever cleared. About a week after starting meds I developed a fever again with coughing. After an X-ray it was determined that I had right lower lobe pneumonia. After a week on Avelox the fever cleared and I felt much better.

On June 21st I got my latest results after starting meds, VL: Undetectable, cd4 688, and cd4% 25. The drugs seemed to work wonders in a month!! However I still have a productive cough with phlegm and Im constantly blowing it out of my nose, its mostly yellowishnever bloody. I run a couple of miles a day have no fever and my energy level is good. Also on June 22 I developed an outbreak of Herpes on my lower lip which I have always been able to control very well with a dose of Acyclovir when I felt it coming on. However Ive been on Acyclovir 800mg per day for the last 3 months per my docs advice as a preventative measure to keep the Herpes virus in check.

My doc didnt seem to be too concerned about my cough and phlegm. Q. Could I still be recovering from pneumonia? Before my next visit in late August I will be taking another X-ray per his orders Also, I thought it was strange to have a Herpes outbreak because Im already taking Acyclovir 800mg once a day for the last 3 months. Could this all just be my immune system coming back quickly? Are my latest results that look great unusual? Should I worry about Immune Reconstitution Syndrome? Will this Herpes outbreak endanger my great results? And, if I do have IRS will my body eventually adjust? Whew?? Ok Im done.

Thanks Again!!

Response from Dr. Henry

Your excellent surrogate marker (CD4 and viral load) response to therapy demonstrate that your HIV regimen worked very well in the precense of a concurrent illness (bronchopenumonia) and a herpes flare. Those conditions as you experienced are not generally linked to immune reconstitution syndrome. It can take a while to clear phlegm production after a pneumonia but clinical follow-up is recommended when symptoms persist. The herpes outbreak should not threaten your response to treatment. KH

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