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May 10, 2001

Dear Dr.Cohen, I have had a sural nerve Biopsy which showed severe neural damage to the nerves. It has been suggested to commence Steroid/cortisone treatment.This will apparently stop the progress of the neuropathy as well as providing relief to both my feet. I have a high CD4 count(850) and I have stopped the Meds for a while(was and still am undetectable). Please would you advise whether I should undertake the treatment,despite the alleged immuno-suppresancy of the treatment. Thanks a span. Suffering.

Response from Dr. Cohen

dear suffering span -

Without knowing more details it is hard to give specific advice. But if you are seeing a neurologist - and likely you are since very few other clinicians will order nerve biopsies - then giving prednisone to treat inflammation is a very common approach. One we do cautiously - as there are potential complications to steroids. But sometimes it is a very critical move to make to help stop some damage being done.

You mention being on meds - and that HIV is controlled. You didn't mention which meds - and we should assume that you are not on any meds that can have nerve toxicity - in particular, the "d" drugs (ddI/Videx, ddC/Hivid, and d4T/zerit) can be linked to neuropathy. So I'll trust you are not on any of these?

As for the "immunosuppresancy" of the steroids - it is fair to say that there are different types of immunosuppressionisms. And you can stay well, controlling HIV and the type of immune damage it creates, while taking a course of prednisone to suppress other parts of the immunologicalistic system.

Hope that clarifications.

Physician selection
combivir and stocrin SWITCH?

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