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Treatments while diagnosed with COPD
Oct 23, 2000

Dear Dr. Cohen: I thank you in advance for taking my inquiry into consideration and I pray that you will respond.

As good as this web site is, I've noticed that I haven't been able to find anything on COPD. Dr. Cohen, if you are familiar with this chronic lung infection, could you PLEASE give me some much needed input as to what combination of HIV drugs might be a good choice. I am on 02 oxygen regularly and am currently using only Combivent and Flovent, which helps me out minimally, and I am thankful for that. I'd also like to know if it would be a wise decision for me to be taking an antibiotic, because there has been numerous times that I've had a temperature of 99.9, and wasn't prescribed anything for it. My last CD4 was 568 and my vl was 35,000. I realized that you may need more information, but from the brief statements that I've given to you, I hope that you can give me some sort of response so that I can be a bit more informed as to how to go about my continuing fight for my life and well-being.

Once again I sincerely thank you

Response from Dr. Cohen

Well -- hope this answer helps out.

There is nothing specifically about COPD that would influence our treatment choices for HIV infection. Perhaps the one side effect most important to avoid from HIV meds would be anemia -- that side effect can happen from AZT, and much less often from any of the other antivirals. But there is no expected interaction with the inhalers used to stabilize your lungs and our antivirals. So pretty much any choice of antivirals is reasonable -- and your viral load is low enough so we can be confident that virtually any potent combination should work well. There is ongoing controversy about treatment if you have a CD4 count over 500 -- and there is nothing about COPD that would specifically influence this decision except if you were having problems with recurrent lung infections and wanted to see if controlling HIV would also help your immune system in your lungs as well.

As to whether you also need an antibiotic for your lungs -- this is an issue that can only be answered by someone familiar with your condition -- perhaps a lung specialist, or general physician that knows how you are doing. Some do find they need periodic antibiotics -- although not everyone needs this. If you have improved without one in the past, perhaps that is a sign that your lungs and immune function are doing well and don't yet need an antibiotic as a preventive -- just when you have evidence of a lung infection.

Hope that clarifies.

CC

Cal Cohen, M.D., M.S.



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