positive and sick
Posted: Aug 30, 2008
QUESTION:
38 y/o white malehiv for 14yrs cd4 ct 318 vl undetectible, c/o malaise, loss of energy, anorexia, fever, night sweats, aches all over, rash on abdomen, neg diarrhea, some sob, mild abdominal pain. on atripla. inflammatory work up neg. abdominal cat scan neg. abdomen soft minimal pain elicited. lungs clear, chest x-ray neg. cultures all neg. cbc wnl. kidneys wnl good function. i am at a loss of what to do next! thanks!
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RESPONSE FROM: 
Thank you for your post.
Your patient presents with very non-specific symptoms with a broad differential diagnosis. With an undetectable viral load and non-critical CD4 count, the likelihood of an AIDS-related complication is lower, but shouldn't be dismissed entirely. While concerning with symptoms of malaise and night sweats, with your extensive work up, I rather doubt that we're dealing with an overt infection or malignancy. Was a tuberculosis skin test, or better yet, interferon-releasing assay performed?
I would wonder if the patient has an endrocrine issue, like hypogonadism, adrenal insufficiency or hypothyroidism. Alternatively, though certainly not typical, it's possible that he is having an adverse reaction to one of his medications, including Atripla. Here a monitored discontinuation of treatment could be entertained.
Last, I would consider the possibility of a mental health issue, such as depression as a contributor.
These are just a few ideas... Best of luck to you and your patient,
BY
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