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Diarrhea / Wasting
Jul 12, 1999

I am currently involved in a protocol at the National Institutes of Health in Bethesda. My CD4 count is consistently in the 600-700 range (33-35%) and viral load has been less than 50 for two years (now 6000 after being off meds for 12 week ). For approximately 7 months I have been experiencing diarrhea (more accurately very loose stool) and consequently have lost about 30 pounds. I also experience periodic high white blood cell counts (13,000 as of Tuesday) that last for a day and then return to the normal range always preceded by high fevers (101-102). My blood work has shown no evidence of any abnormalities (other than the white count), I have been tested for virtually every disease/infection known to man, my stool samples show no parasites etc. and I am losing patience (as well as too much weight). I have started believing that (as some nutritionalists think) I am perhaps not digesting fat, am lactose intolerant or perhaps have a food allergy. The docs at NIH don't hold any credence to these possibilities but what else could it be? Thanks in advance.

Response from Dr. Dieterich

That is indeed a tough question. I would certainly recommend endoscopy and small bowel biopsy and colonscopy and biopsy if they have not been done already. I also would do a CT scan and small bowel series, again if not already done. A 30 pound weight loss is significant. If all is negative I might try a trial of antibiotics. You could have a small nidus of salmonella or shigella hiding somewhere. Do you have gallstones? Malabsorption or food allergies would not elevate your white count. I always assume everyone is lactose intolerant, so be sure to go on that diet immemdiately. Good Luck Douglas T. Dieterich, M.D.

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