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Author Topic: Immune reconstitution?  (Read 1978 times)

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Offline ATLpozbrother

  • Member
  • Posts: 26
  • I'm Sick and tired of being Sick and tired.
Immune reconstitution?
« on: March 09, 2012, 06:35:14 PM »
I had a sinus (upper respiratory) infection, which is not so unusal, since I have a history with my sinus, but this time I found myself in bed for two days taking over the counter meds, within a few days I experienced a swollen lymph node under my chin and one  to the left of my chin on my neck.  They started off as small but have now grown, I've developed an insecurity as my neck has a obvious swelling.  I went to my doctor and she did state it may be IRIS associated with the sinus, so she treated me with Rocehpin infection (1gm) and I'm taking Amoxicillin for 10 days 2x a day.  Its been 4 days and I'm not seeing any decrease in swelling of the lymph nodes.  How long will this last? How long does IRIS last.  I've been on The Quad Pill for about two months and have had huge drops in VL and a quick increase in CD4 count.  Its just hard walking around with this large lump on the side of my neck.  :-\
10/11 cd4 23, VL 125000-hospitalized PCP
1/12 started Gilead vaccine trial-The Quad Pill
1/12 cd4 40,   2% VL 445,000
2/12 cd4 153, 6% VL 43
3/12 cd4 248, 8%  VL 1023
4/12 cd4 215          VL 99
4/22 cd4 208, 8%  VL undetectable.
5/12 cd4 168, 9%  VL undetectable
9/12 cd4 176, 10% VL undetectable

Offline jkinatl2

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  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Immune reconstitution?
« Reply #1 on: March 09, 2012, 07:10:13 PM »
I foolishly let my cd4 count get down to the tweens, and my viral load exceed three million, and then decided to get back onto meds.

Not only did I develop IRIS, but unmanaged PCP and other junk surfaced as well. Two weeks in a hospital, much of that time on powerful steroids to counter the effect of IRIS (and of course, to then wean me off the steroids - crazy powerful stuff).

I am surprised your doctor, having diagnosed you with IRIS, did not give you at least a mild course of steroids to counter the inflammation. Maybe you should call his/her office and ask, if it hasn't dramatically improved over the weekend? I'd feel rather impatient walking around with a lump on my neck as well.

Nice improvement in numbers however. Moving from the danger zone is always a good thing.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline ATLpozbrother

  • Member
  • Posts: 26
  • I'm Sick and tired of being Sick and tired.
Re: Immune reconstitution?
« Reply #2 on: March 09, 2012, 09:19:34 PM »
PCP is a danger zone...unfortunately, it was how I discovered I was positive, it started with a week-long dry cough, then problems breathing, within 8 days I went from hitting the gym to being hospitalized for 6 days, first time ever being hospitalized... it happened all so fast, I still struggle with this fact.   Once you have PCP &  leave the hospital the recovery takes so long...I was on long term Bactrim and Prednisone for many months. I tested negative some years ago, thought i was ok.  thanks for your comment...My doctor wants me to come back to her office Tuesday, I was just hoping to have it under control by then.  My doctor just seems to think steroids will push down my CD4 count, but I'm more concerned about this lump on the side of my neck, the anti-biotics are helping the sinus, but the swollen lymph nodes are not really decreasing in size.  Out of desperation, I went to an accupuncturist today, maybe this will help...lets hope at least... :-\
10/11 cd4 23, VL 125000-hospitalized PCP
1/12 started Gilead vaccine trial-The Quad Pill
1/12 cd4 40,   2% VL 445,000
2/12 cd4 153, 6% VL 43
3/12 cd4 248, 8%  VL 1023
4/12 cd4 215          VL 99
4/22 cd4 208, 8%  VL undetectable.
5/12 cd4 168, 9%  VL undetectable
9/12 cd4 176, 10% VL undetectable

Offline Matty the Damned

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  • Ninja Please
Re: Immune reconstitution?
« Reply #3 on: March 09, 2012, 09:34:15 PM »
PCP is a danger zone...unfortunately, it was how I discovered I was positive, it started with a week-long dry cough, then problems breathing, within 8 days I went from hitting the gym to being hospitalized for 6 days, first time ever being hospitalized... it happened all so fast, I still struggle with this fact.   Once you have PCP &  leave the hospital the recovery takes so long...I was on long term Bactrim and Prednisone for many months. I tested negative some years ago, thought i was ok.  thanks for your comment...My doctor wants me to come back to her office Tuesday, I was just hoping to have it under control by then.  My doctor just seems to think steroids will push down my CD4 count, but I'm more concerned about this lump on the side of my neck, the anti-biotics are helping the sinus, but the swollen lymph nodes are not really decreasing in size.  Out of desperation, I went to an accupuncturist today, maybe this will help...lets hope at least... :-\

Yeah, I remember your history with the pred. Prednisolone is a dual edged sword. I'd tend to agree with your doctor, pushing your CD4 count back down isn't going to help much.

Nor will acupuncture for that matter.

MtD

Offline ATLpozbrother

  • Member
  • Posts: 26
  • I'm Sick and tired of being Sick and tired.
Re: Immune reconstitution?
« Reply #4 on: March 15, 2012, 08:34:48 PM »
Its approaching 30 days since the swollen glands under my chin and to the left of my neck appeared, after I was experiencing a sinus infection.  I went to my doctor and she prescribed Amoxicillin 2x a day for 10 days.  I'll be taking the last of my meds tomorrow, but the swollen glands are still there.  My doctor states it will just have to take more time, she made little to refernce to IRIS, I brought it up to her.  Seeing my doctor was a waste of time, she only observed the swollen nodes, and said I was fine.  She wants to see me in a week....right, another co-pay and submission of charges to my insurance company...so sad.  Has anyone been through this and can someone advise me on what to do?  Should I seek a specialist who's familiar with this type of complication?  I'm becoming a hermit, not wanting to be around people with this swollen lymph node, thank god I have a private office at work.  On the positive side, I found a dermatologist who's helping me with the dry skin issue...thank god for great insurance.  Looking for anwsers regarding the swollen nodes...just never had anything like this, and need a resolution, I've developed so much anxiety over this issue.  :-\
10/11 cd4 23, VL 125000-hospitalized PCP
1/12 started Gilead vaccine trial-The Quad Pill
1/12 cd4 40,   2% VL 445,000
2/12 cd4 153, 6% VL 43
3/12 cd4 248, 8%  VL 1023
4/12 cd4 215          VL 99
4/22 cd4 208, 8%  VL undetectable.
5/12 cd4 168, 9%  VL undetectable
9/12 cd4 176, 10% VL undetectable

Offline Rhaegar

  • Member
  • Posts: 102
Re: Immune reconstitution?
« Reply #5 on: March 19, 2012, 12:58:47 AM »
Is it possible to get a second opinion from another doctor?
05/19/2011: Diagnosed.  CD4 159   VL 284,000.
04/29/2013:  CD4 789,   VL <20

Offline ATLpozbrother

  • Member
  • Posts: 26
  • I'm Sick and tired of being Sick and tired.
Re: Immune reconstitution?
« Reply #6 on: March 19, 2012, 10:37:19 PM »
I'm going through IRIS and have developed Mycobacterium avium complex (MAC), which has caused swollen lymph nodes under my chin and to the left of my neck.  The lymph nodes are very noticible and I'm developing a phobia.  I am approaching one month since they have appeared.  I have seen a general practitioner who have placed me on the antibiotic clarithromycin for 30 days.  It's been 3 days since I started the meds, but still haven't seen a decrease in the size of the lymph nodes.  I have made an appointment to see another Infectious Disease doctor this Friday.  I'm just wondering when this MAC will go away and when will these large lymph nodes go away.  Still taking meds nightly, just going through lots of anxiety with the unknown of when these nodes will go away.  :-\
10/11 cd4 23, VL 125000-hospitalized PCP
1/12 started Gilead vaccine trial-The Quad Pill
1/12 cd4 40,   2% VL 445,000
2/12 cd4 153, 6% VL 43
3/12 cd4 248, 8%  VL 1023
4/12 cd4 215          VL 99
4/22 cd4 208, 8%  VL undetectable.
5/12 cd4 168, 9%  VL undetectable
9/12 cd4 176, 10% VL undetectable

Offline littleprince

  • Member
  • Posts: 201
Re: Immune reconstitution?
« Reply #7 on: March 22, 2012, 06:00:18 AM »
I can't give you any advice on the MAC but it's good that you're going to an ID doctor. GPs can be great but often have limited knowledge when you start getting into opportunistic infections.

From your numbers I can tell that you have had a pretty rough few months. The good news is that the first few months are the worst after coming from such a low CD4 count. You're over the 200 'hump', let the ID dr get the MAC under control and then it's all up from here. Let us know how the appointment goes.

Offline J.R.E.

  • Member
  • Posts: 7,161
  • Joined Dec-2003 Living positive, since 1985.
Re: Immune reconstitution?
« Reply #8 on: March 22, 2012, 08:04:55 AM »
hi,

Here's an article that may help to answer, some of your questions. I went through IRIS, back in 2003, shortly after starting on meds. And, just like the person in the article, I had the same issues, with eye infections. I think it lasted about 3 weeks, until my eye infections, started clearing up.

I think this article explains it well:

http://aids.about.com/od/otherconditions/a/immunerecon.htm


LZ had been diagnosed with a CMV infection in the right eye. After several days of treatment, the eye infection improved and LZ was discharged from the hospital. A week later during a follow-up appointment with his HIV specialist, LZ was started on HIV medications. And why not? His eye was healed, he felt much better, and the goal afterall is to control HIV replication preserving the immune system in the process.


After a couple weeks on his HIV regimen, LZ developed a fever, blurred vision, and swelling around his eye. The odd thing was that his CD4 count had gone up dramatically since starting HIV medications. So what was going on? His immune system was better, yet his eye looked horrible. LZ was seen by his doctor and was diagnosed with immune reconstitution syndrome. What is immune reconstitution syndrome? It sounds good so why did LZ have another severe eye infection? Let's take a look at this odd syndrome and try to make some sense out of it. The first step is to understand the immune system.

Know & Understand Your Immune System

Immune System Basics
The body has a built in defense mechanism that fights off infection and illness; the immune system. The body's immune system is comprised of several types of cells and processes that recognize and fight foreign invaders such as bacteria, parasites and viruses. Unfortunately, in people infected with HIV, the immune system is damaged, making it more difficult for the body to fight off these infections. How can we tell how healthy the immune system is? The answer is simple; by measuring the number of specialized immune system cells known as the CD4 cell. The higher the CD4 count the stronger the immune system.

Parts of the Immune System

What is a CD4 Count - Why is it Important?

How Do We Know the Immune System is Working?
When an infectious organism enters the body, a series of reactions occur that signal the immune system is working to fight off the infection. The reactions are collectively known as inflammation. Those inflammatory signs that the immune system is working include:

    fever
    swelling at the site of the injury or infection
    redness of the site
    thick drainage and discharge from the site of infection
    warmth and pain at the site

In a damaged immune system some immune system functions may be absent.

What Is Immune Reconstitution?
Studies have shown that if HIV can be controlled by HIV medications, the immune system can repair itself. This immune rebuilding or reconstitution means that after repairing the damage done to the immune system, the body is better able to fight off those opportunistic infections that would otherwise make the person sick. As the HIV is controlled by medications, the body's CD4 count will rise, meaning the immune system is becoming stronger.

Opportunistic Infection Fact Sheets

What is Immune Reconstitution Syndrome?
Remember, if the body's immune system is damaged by HIV, the inflammatory process necessary for healing will not occur. That inflammatory process will return as the immune system is reconstituted. Take our example of LZ and his eye infection. Antibiotic treatment killed off much of the infectious organism responsible for the eye infection. Because LZ's immune system was damaged, the was no inflammatory process present; no redness, swelling, etc. When the HIV medications strengthened his immune system, the body sensed the remaining infectious organism in the eye, left behind after the antibiotic treatment was completed. Sensing the organisms, the newly reconstituted immune system triggered an inflammatory response, resulting in swelling, redness, discharge from the eye and fever. While LZ's immune system was healthier, his eye infection returned. This is the irony of immune reconstitution syndrome.

Is Immune Reconstitution Serious?
While immune reconstitution syndrome signals a healthier immune system, it can be a serious, sometimes fatal condition. Depending on the infection present, aggressive treatment is necessary to prevent serious illness. Common infections that occur during immune reconstitution include

    Pneumocystis Pneumonia
    Herpes
    CMV Infections
    MAC Infections
    Apthous Ulcers
    Tuberculosis (TB)

What Can Be Done About Immune Reconstitution Syndrome?
Again, reconstituting the immune system is a good thing and while that process is desirable, the infection and inflammatory process present in immune reconstitution syndrome must be addressed. Treatment can include:

    Continuation of the current HIV medication regimen.
    Antibiotic or antiviral medications to treat the infection.
    Steroids to temporarily suppress the inflammatory process.

Immune reconstitution syndrome is a complicated and confusing issue that has surfaced since the advent of HIV medications. If your doctor suggests you have reconstitution syndrome, ask a lot of questions and understand the syndrome and the plan of care completely before leaving his or her office.
Suggested Reading

    Understanding the Immune System Response
    Parts of the Immune System
    Opportunistic Infections

Related Articles

    HIV - AIDS - Is HIV and AIDS the same thing?
    HIV - AIDS - HIV AIDS Information - HIV Basics - AIDS Basics - Basic AIDS I...
    HIV and AIDS - What Is The Difference Between HIV and AIDS
    HIV Infection - HIV - Opportunistic Infections - HIV Infection
    HIV and AIDS - Are HIV and AIDS the Same


Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Offline ATLpozbrother

  • Member
  • Posts: 26
  • I'm Sick and tired of being Sick and tired.
Re: Immune reconstitution?
« Reply #9 on: March 25, 2012, 10:16:22 PM »
Thanks for responding...the article is intersting and falls in line with the research i've read.  Since my last post i've seen my main doctor and she states my swollen lymph nodes under my chin and on the left side of my jaw are not concerning.  I made an appointment with another infectious disease doc for a second opinion and he said he's very concerned.  My nodes are like golf balls and hard, he scheduled a CT scan tomorrow afternoon and refered me to a ENT.  Its been 30 days and these nodes are still here....ive become a prisoner not wanting to do anything social...who would with swollen nodes...just wish someone who went through the swollen nodes umder the chin and neck would respond, it appears to be a common location based on my searches....i'm just hoping they wont stay this size forever :'(
10/11 cd4 23, VL 125000-hospitalized PCP
1/12 started Gilead vaccine trial-The Quad Pill
1/12 cd4 40,   2% VL 445,000
2/12 cd4 153, 6% VL 43
3/12 cd4 248, 8%  VL 1023
4/12 cd4 215          VL 99
4/22 cd4 208, 8%  VL undetectable.
5/12 cd4 168, 9%  VL undetectable
9/12 cd4 176, 10% VL undetectable

 


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