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I work in healthcare as a Nurse
Feb 24, 2005

I'm a RN and I work in multiple areas throughout the hosptial setting. One day I may have a MRSA or VRE patient, the next day I may be in the ER exposed to everything and anything. Ive been positive 2 yrs and havent started med. Recently I was took Cipro for 14 days for a chest cold with no results. I went back to My MD and was dx with PCP and started on Mepron. I need to take this for 21 days. My T cells are 174 and viral load 71,000. both of which are twice as bad as previous test. I feel I need to get out of nursing for my own health and was wondering what your opionin was on ths matter. Also I return to my MD next week so I'm assuming he will start me on Antivirals. Which do u reccommend to start? Any thinkg I can do to protect myself other than Universal percautions at work? HELP FEELING LOST.

Response from Dr. Pierone

Hello and thanks for posting.

It sounds like you are going to need antiretroviral medication based on your numbers and recent diagnosis of PCP. The DHHS guidelines for management of HIV infection suggest triple therapy for treatment-nave patients. There are many agents and possible combinations, but for initial therapy a NNRTI like Sustiva is commonly used as the linchpin medication. Sometimes Viramune is prescribed instead depending on individual doctor/patient considerations. In terms of the nucleoside backbone, a trend favoring Truvada has emerged, but Epzicom and Combivir are used as well. Protease-inhibitor based therapy is also an option, but typically is reserved for later use because of greater pill burden and toxicity.

Our team cares for a considerable number of nurses and health care professionals with HIV infection. In general, being exposed to sick patients does not have much of an impact on their health. Hand washing, gloves for wound care, and protective masks for suspected TB are interventions that limit health care worker risks. That said, everyone has a different threshold of risk tolerance and the decision to stay in healthcare is a personal one that depends on many factors. Perhaps changing from front-line care to an administrative position might be an option. It also makes sense to see a counselor in order to explore potential options. Good luck to you!

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