Does HIV make someone more susceptible?

Mad about Z

HIV vs. AIDS

Does HIV make someone more susceptible?

My son is a certified medical assistant who works daily with people who are ill. He has a CD4 count of 311, and he takes no HIV meds at this time.

I am concerned because he has begun breaking out in numerous rashes on his face, neck, and chest. Last month, he became ill at the clinic where he works, nearly losing consciousness because he could not breathe. He was given erythromycin by needle, and Benedryl, then rushed to the E.R. Still, no-one knows what caused the “attack.”

My son has a friend who has AIDS. Would an AIDS patient transfer something to my son that would make my son in worse condition, assuming all precautions are taken?

The short answer is no—HIV is transmitted through the exchange of bodily fluids during sexual contact with an infected person, sharing needles and syringes or other drug works with someone who is infected, during pregnancy or labor and through breast-milk of someone infected with HIV, or very rarely in the U.S. via transfusion of infected blood or blood products. It does appear to be possible for a person with HIV to become infected with a second strain of HIV through some of the ways listed above, running the risk of acquiring drug-resistant virus, for example.

It sounds like your son is doing good things for himself—working hard, keeping up with his medical care, talking with his mother... If his CD4 count is staying below 350, it is likely time to actively review the pros and cons of starting antiretroviral therapy. Other healthy behaviors include eating a balanced diet, getting enough sleep, exercising regularly, avoiding tobacco, alcohol and other drugs, and practicing safer sex (just to name a few).

—Aimee Maree Wilkin, MD, MPH, AAHIVS, Wake Forest University, School of Medicine, Winston-Salem, NC

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Mad about Z

I am an HIV-positive nurse and an asthmatic. When I get a cold I usually get a chest infection, so I usually get a course of Z-PAK. My current doctor advised me to take Sudafed and Tylenol instead of prescribing the antibiotics. I am hacking up gobs of yellow sputum, though, and am mad enough to switch doctors. Why when I have cold that usually leads to a secondary chest infection, would it be contraindicated to have a course of antibiotics for my chest, especially when I’m HIV-positive?

In treating what sounds like recurrent bronchitis after upper respiratory infection, data on antibiotics are controversial, and may actually suggest that they are unlikely to help. More appropriate treatment may be risk reduction behavior like reducing exposure to smoke and allergens, inhaled steroids, bronchodilators, and mucolytics.

—John W. Gerwig, PA-C, AAHIVS, John Hopkins University, Baltimore, MD

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HIV vs. AIDS

I need to know how you tell the difference between being HIV-positive and having full-blown AIDS. My son has told me he is HIV-positive and I am scared to death. The doctor has told him he will be taking a medication that will make him sick. He lives in Chicago, I live in Michigan and I am retired and I do not know what to do to help.

You may want to help your son seek care from an HIV Specialist™ . Your son’s provider may not be current with the new medications and their side effects. “HIV-positive” means that the person is infected with HIV, which affects the immune system. An AIDS diagnosis occurs when the immune system declines to a certain point (under 200 CD4 cells), or the patient develops certain illnesses, like PCP pneumonia. In my 12 years as an HIV care provider, I have seen many patients with advanced AIDS who begin treatment and do very well for many years.

I reassure all of my newly-diagnosed patients that when they need to begin HIV medications, they have excellent treatment options. We see significantly fewer side effects with new medications than we saw years ago. My patients have returned to work, completed college courses and enjoy healthy, active lives.

Your local HIV community-based organization or health department can help answer your questions. AAHIVM’s “Find A Provider” search at www.aahivm.org can help you find an HIV Specialist™ in your area.

—Kathryn L Hall, RN, PA-C, AAHIVS, Yellowstone City County Health Department, Billings, MT

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E-mail your questions to aahivm@tpan.com, or send a letter in care of “Ask the HIV Specialist,” TPAN, 5537 N. Broadway St., Chicago, IL 60640.

The American Academy of HIV Medicine (AAHIVM) is an independent organization of physicians, nurse practitioners, physician assistants and others dedicated to advancing excellence in HIV care through the HIV Specialist™ credentialing program, advocacy work and continuing education opportunities. E-mail your questions to aahivm@tpan.com.