Question
How should I treat advanced HIV (CD4 = 68)? I am a doctor.
25 December 2022. Related: All topics, CD4 and viral load, Newly diagnosed, Opportunistic infections, Support.
I have a female patient diagnosed with CD4 count 68 on ART with dolutegravir + lamivudine + tenofoir. Her weight is about 58 kg.
She is bed ridden and is unable to do regular activities. She is also on liquid diet due to mouth sores and poor appetite.
What are my chances at this stage. I am really worried if I should look for a hospital.
Answer
Hi there
It sounds like you are a doctor who has limited experience of HIV – although you didn’t say this explicitly, or include your country.
My first response if to please contact one of the largest HIV hospitals in your country to seek specialist advice.
Any CD4 count <200 is classified as very late diagnosis which increases the risk of serious complications from opportunistic infections. As the CD4 is actually much lower and <100 seeking expert advice from a doctor with this experience is urgent.This includes using prophylactic treatment until the CD4 count becomes much higher on ART.
This person might easily have gut infections and/or candida that explains low appetite,
If this person started treatment with a CD4 count <50 there is also a risk of other serious infections being uncovered by HIV treatment. This is called IRIS and also needs careful monitoring.
With proper care, the current HIV combination can be very effective for a long term recovery, including a much higher CD4 count, but they need expert care to diagnose current infections.
Please contact HIV specialists in your country for advice including doctors at the closest large HIV clinic to consider admission to hospital.
Please also email i-Base if you would like to discuss this further. Although we are not doctors, we caan suggest additional options.
WHO guidelines on management of advanced HIV (2017) Â include information about the most serious opportunistic infections.
https://www.who.int/publications/i/item/9789241550062
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