Muscle pain and high white blood cell count

Question

Dear Dr. Frascino:

I have been positive for 21 years, and have been shown to be resistant to all current medications. I have recently had a drop in my white blood cells and have been told that I should restart Fuzeon treatments in anticipation of new medications to be released later this year. I am writing not specifically about the resistance, but because I have recently been feeling some severe joint and muscle pain that is all over my body. Could this be related to my low white blood cell count or currently high viral load, or might there be other causes? Have there been any successful treatments of such symptoms among patients? I'm not sure what to do, but it is becoming difficult to move and I am sore all over.

Any advice is appreciated.
Best, In pain

Answer

Hello In Pain,

Low white blood cell counts and/or high HIV plasma viral loads would not directly cause joint or muscle pain. There are a wide variety of potential HIV-associated conditions that can have joint and muscle pain associated with them, including various opportunistic infections, rheumatologic problems, neuropathy and other primary nerve or muscle problems, avascular necrosis and other bone problems, etc. I would suggest you see your HIV specialist for a thorough evaluation of this problem. Successful treatment would depend on identifying the underlying cause of the problem.

I would also question the decision to begin Fuzeon if you are "resistant to all current medications." It would be preferable to begin Fuzeon with one or more drugs that your virus still shows some degree of sensitivity to. In addition, there are several drugs in the "expanded access" programs that might very well prove useful to you. Alternatively, there are a number of clinical trials that you might also consider enrolling in, if your other options have indeed been exhausted.

Good luck.

Dr. Bob