Dear Keith,

I am HIV+ and i am currently on Atripla. My CD4 is circa 450 and undec. I have recently been diagnosed with Ulcerative Colitis and unfortunately my initial treatment of Asacol 3 x day hasnt worked. Now my doctor wants me to go on 40mg of Prednisolone per day.

I am very scared and frightened about going onto these steroids as i know they are immunosuppresants. I know a trial was conducted a few yrs ago showing that a low dose (5mg) of predisolone can increase CD4 levels, but nothing was conducted at the high dose i will be taking.

I obviously dont want to risk taking anything that will kill my immune systema and put me at higher risk of infections.

What do you recommend?

Thanking you in advance

I have had a number of patients (including several with inflammatory bowel disease) who undergo periodic steroid treatments for other underlying conditions. Most do well with that (better yet if decent CD4 counts and HIV levels suppressed as in your case). Steroids can decrease CD4 counts on a temporary basis. For many patients treatment of serious underlying health problems is key to their overall health and fortunately more and more HIV patients on ART can be successfully treated for those conditions. More careful monitoring is suggested during steroid therapy. There is increased concern about bone issues, possible flares of tuberculosis and other conditions during use of steroids that support more careful monitoring. KH