Face HIV with Dr. Watiti

Feb 20, 2007

Dear Doctor, <br>I am HIV-positive with a CD4 above 200. I am supposed to take septrin daily, but because I am allergic to it, I was advised to take dapsone tablets. I have reacted to them as well. I have stopped taking them and I am much better. I am worried even though I am in a good condition at

I am allergic to septrin

Dear Doctor,
I am HIV-positive with a CD4 above 200. I am supposed to take septrin daily, but because I am allergic to it, I was advised to take dapsone tablets. I have reacted to them as well. I have stopped taking them and I am much better. I am worried even though I am in a good condition at the moment. What can I take apart from those two drugs, to prevent TB?
Anne

Dear Anne,

Septrin is given to all people living with HIV/AIDS (PLWAs) because it has been found to prevent infections such as respiratory tract infections, diarrhoeal diseases and even malaria. It does not prevent TB as you suggested in your question though. It is part of the basic care package for PLWAs.

Unfortunately, some people who are allergic to sulfa-containing drugs, to which group septrin belongs, can react to it. These people may be put on dapsone though it does not protect one against malaria like septrin does.

What we sometimes do is to try and de-sensitise such people by introducing septrin in small doses and increasing the dose gradually to see if they can tolerate the drug.
This should only be done under the supervision of a qualified and competent doctor.

Because you seem to be sensitive to both septrin and dapsone, it may be necessary for your doctor to re-assess you and see whether you should not be put on ARVs, especially if your CD4 count is above 250cells/ml. Remember to make sure that you have the other components of the basic care package for PLWAs.

This includes sleeping under an insecticide-treated mosquito net, having a balanced diet and observing hygiene. Concerning your worries, I recommend that you see an HIV counsellor who can help you cope with the stress that HIV puts on anyone who has it. Worrying will cause your immunity to deteriorate faster.

The counsellor will help you understand and adopt the concept of positive living, which is very important for all PLWAs. It helps you to accept your condition, to care for yourself and to protect others from being exposed to HIV infection.

My husband is paralysed

Dear Doctor,

My husband and I went for a routine HIV test two months ago and we were surprised when he turned out to be HIV-positive, while I was negative. We were advised to check again after three months. Last week, however, my husband woke up one morning and was paralysed on the left side and having difficulty in speaking! What do we do now and what could be the cause of this sudden deterioration in his health?
Martha

Dear Martha,

Going for an HIV test when you are not feeling sick is very good and should be commended. It is a pity that your husband was not offered a follow up CD4 count test to find out how much damage HIV had done to his immune system. It is possible to have no signs or symptoms at all even when your immune system is badly damaged.

What has happened to your husband could be due to a disease called toxoplasmosis, which is common in advanced HIV infection when the CD4 is very low, for example 100 cells/ml or less. The normal CD4 count ranges from 500-1500 cell/ml.

Toxoplasmosis causes brain abscesses, which can lead to what he is having now.
What should be done now is to find out his CD4 count and then undergo a thorough physical examination to rule out other causes of his paralysis, such as a stroke due to high blood pressure.

If he is found to be eligible for ARVs, he should start taking them after adherence counselling. He will also need the services of a physiotherapist to help him regain use of his paralysed side if possible.

Lastly, your husband’s experience underlines the importance of all people in our community knowing their HIV sero-status, because it is possible for one to have a badly damaged immune system without knowing it.

You should for another HIV test as you were advised because having been exposed to HIV, you could turn out to be HIV-positive. But this should not scare you because there is also a possibility that you are still HIV negative. HIV discordancy is a recognised phenomenon.Discordancy is where on partner is negative and the other positive.

Send your question on HIV to Health Editor, The New Vision. P. O. Box 9815, Kampala or
health&beauty@newvision.co.ug

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