very low platelet counts

Question

I tested hiv+ in 1993. Have been on combivir and Viracept since 1995. T cells 500-600 and viral load were below 50 until Nov 2000. Then I became sick with colds and stomach flu,fevers night sweats and bad joint pain. In Jan t cell started to fall and viral load going up along with low platelet count. In end of Feb tcell went to 356 and viral load to 1000.My platelet count fell to 38. In march the same except platelet is 69.My Hiv dr says we should just watch and check in 1 mo. Is there anything you can say that would be causing this. Thanks PEB

Answer

Dear PEB: I actually don't even agree with the title of your query. Your platelet counts are low, but not what I would call "very low". Although the normal platelet count is usually above 150,000 (the actual value depends on the laboratory performing this measurement), a human being can live quite well with a platelet count over 20,000. Only if the platelet count falls below 20,000 or below 10,000, then patients spontaneously bleed in the gums, nose, bowels and so on. So if your platelet count settles in the range between 38,000 (what you call 38) and 69,000 (what you call 69), the advise of your doctor is quite sound, i.e. just watch and wait. As for what causes this; low platelets are VERY common in HIVers. Basically as your body mounts an immune response, you produce antibodies against HIV. Some of these antibodies by accident kill platelets. Although there are indeed ways to raise the platelet counts, there's no reason to do so in your case. If you need to have surgery (e.g. a dental extraction), then at that point, you should take some action (and there are many possibilities) to raise your platelet count for whatever procedure is being planned. Hope this answers your question. BD.