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Ongoing MRSA Abscess
Jan 25, 2009

I'll start with a little background on me. I started treatment with a VL of 353K and CD4 count of 3 in Dec of 07. I was also hospitalized for a month with Crytococcal Meningitis. I lost a tremendous amount of weight but have since bounced back. I waited too long to deal with the HIV. That's all in the past though and I'm looking forward. My counts have since gotten better, though need improvement still. My VL in Jan of 09 was 121. Since the initial drop when I started treatment, it has been back and forth from 220 or so and 120, never quite undectable. My CD4 is up 224 and has slowly been climbing. My doctor says that its a low VL and doesn't seem too concerned that its not undetectable. I'm unsure. I am currently taking Atripla, Fluconazole 200MG/day.

I've had an ongoing complication with an abscess in my groin that is MRSA. It initially started in April of 08 and I was put on Bactrim, had it lanced, drained. It popped up again in Oct of 08 and repeated the process. It came back in early Jan and my doctor put me on Bactrim and wants me to stay on it for awhile to prevent it from coming back. It initally seemed to go away quickly, but now is tender again and I'm thinking it might be back, even though I'm taking the Bactrim. I also presently and battling a bout of Shingles (mild and not really that bothersome) and am taking Acyclovir 800mg/5 times a day/10 days. I know this is a long winded question, but I'm curious if the 2 are related and if the abscess is being treated correctly. My doctor says these things tend to come back. Even when it hasnt been tender or swollen, there has always been a hard pea size knot there that he says is scar tissue. What should I do about this abscess?

Response from Dr. Henry

MRSA infections are often hard to eradicate even in HUIV- persons. There often is persistent colonization in areas like the nose that lead to frequent recurrence. Long term treatment is often necessary and often that is independent of the HIV/immune status (long term Rx often needed if doing well with high CD4 counts) since that is the nature of MRSA infections. KH



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