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Author Topic: Looking for TB and Cat related advice for HIV+ partner  (Read 2554 times)

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Offline magnoman

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  • Posts: 26
Looking for TB and Cat related advice for HIV+ partner
« on: November 28, 2012, 02:54:51 PM »
Hi there,

A new posting from me.

Just got results from my boyfriend's tests:

13th August CD4 551 VL 88035
4th November CD4 404 VL 21737

He came back from the clinic this morning with the results and they are as above.

He does not have TB and was vaccinated with a BCG when he was a child against TB, however the doctors have suggested that as there are relatively high rates of TB in this country that he should start a year long preventative course against TB.

The pills they want him to take are called Isoniazid, and they appear to be relatively safe, although Wikipedia does say that there can be side effects.

To the best of my knowledge they didn't do a test to see if he has imminuty against TB from his childhood BCG, so I am interested to hear whether anyone knows anything about this.

Also I understand that they do not provide any HIV medication here until the Tcells drop below 250, which I understand is also the case in the UK, but in the USA it is 500.

Wouldn't mind hearing from people about the advantages of getting on HIV Medication now rather than waiting for the T-cells to drop below 250, although I am not even sure whether that would be possible as I understand that the government regulates HIV medication here and there are no private treatment facilities.

This is a fairly new diagnosis from the beginning of this year.  The first HIV test was positive, the Western Blot was negative, the second HIV test was positive and the second confirmatory test wasn't a Western Blot but was positive.

Finally the doctors suggested that us having a cat was not a good idea, which sounds kind of extreme to me so I was interested in peoples thoughts on cat ownership as well!

Anyway any advice would be much appreciated.

Thanks.

Offline WillyWump

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  • your ramblings bore Yamaguchi Kitteh
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #1 on: November 28, 2012, 05:32:32 PM »
Hi Magnoman,

I cannot comment on the TB, but I am a cat owner and have been around cats for my entire infection with no problems. There are many cat owners on here and they will tell you the same.

I think the problem is with the litter box , you just have to be careful when handling it (but even neggies should handle carefully, right?), you dont have to go to extremes. I use surgical gloves when cleaning the box and also avoid inhaling the dust, but that's probably not even necessary. Just clean up real well with warm water and soap afterwards.

Enjoy Mr. Kitty :)

-WIll

« Last Edit: November 28, 2012, 05:36:33 PM by WillyWump »
POZ since '08

Last Labs-
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline hope_for_a_cure

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Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #2 on: November 28, 2012, 05:50:30 PM »
Hi Magnoman,

Just clean up real well with warm water and soap afterwards.

Enjoy Mr. Kitty :)

-WIll

That's what I do too. 

Also, on those rare occasions when I get a little scratch from playing with my cat, I clean the cut with plenty of hydrogen peroxide and apply Bacitracin first aid antibiotic ointment afterwards. 

Offline leatherman

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  • Posts: 6,154
  • Google and HIV meds are Your Friends
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #3 on: November 28, 2012, 07:20:37 PM »
Finally the doctors suggested that us having a cat was not a good idea, which sounds kind of extreme to me so I was interested in peoples thoughts on cat ownership as well!
Toxoplasmosis is an opportunistic infection that can occur when one has a severely comprised immune system - like having an AIDS diagnosis. It can be transmitted from cats feces to humans if precautions are not taken (gloves, washing hands, not breathing in used cat litter dust)

Is your doctor a reputable HIV doctor? this seems like a very big over-reaction by your doctor since your BF is no where near an AIDS diagnosis right now.

while I have only 3 dogs now, I had a cat who lived to be 19. She lived with me through some of the worse years of my life (92-02) when I had AIDS, was in and out of the hospital, and sick with a lot of things - but never toxo. The simple precautions like others have stated (though I never used gloves or masks) should totally protect you.

As a bonus to protecting your BF from toxo, washing hands frequently will also protect from a lot of other illnesses. ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline anniebc

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  • Posts: 5,939
  • AM member since 2003
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #4 on: November 28, 2012, 08:16:48 PM »
Hi Mag

I volunteer at an animal shelter, at the moment we have 35 cats and kittens.  About 7 weeks ago I had a few problems going on and my CD4's dropped to 180, the advise my ID Doc gave me regarding the cats was be careful, she never once told me to give up caring for the cats.

The guys have given you some good advise, listen to them and take care, I have two dogs and a cat at home and have never had any problems.

Aroha
Jan
-----------------------------------------------------------------------
Never knock on deaths door..ring the bell and run..he really hates that.

Offline magnoman

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  • Posts: 26
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #5 on: November 28, 2012, 10:11:11 PM »
Thanks for the cat advice.

I am pretty sure we will be keeping him.  I originally got him to try and cheer my bf up about his diagnosis, so I was pretty upset that the doctor said we should get rid of the poor thing.

Sadly I am not sure that the HIV doctors here are brilliant, I suspect they are more overworked than anything and as far as I am aware there is just the one treatment center in this city.  As I say it is all regulated by the government so you get what you get!

I'm still a little worried about the TB medication they want him to take.  It seems to me that if he was vaccinated as a child they should at least be testing to see whether he is still immune rather than trying to get him to take three pills a day for the next year.  He already has to look forward to HIV Medication in the distant future.


Offline leatherman

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  • Google and HIV meds are Your Friends
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #6 on: November 29, 2012, 12:19:19 AM »
here's some info about that med that was easy to find by googling up "Isoniazid package insert"
Quote
Isoniazid Dosing Information

Usual Adult Dose for Tuberculosis -- Active:

Active infection: 5 mg/kg (up to 300 mg) IM or orally once a day, or 15 mg/kg (up to 900 mg) 2 to 3 times a week. Therapy is usually continued for 6 months, or 3 months beyond culture conversion (when given with rifampin and pyrazinamide).

Latent infection: 10-20 mg/kg/day orally once a day, not to exceed 300 mg/day

If isoniazid and pyrazinamide are used alone, isoniazid should be continued for 9 months. If the patient is HIV-positive, therapy should be continued for at least 9 months, or for 6 months beyond culture conversion. Longer duration of therapy should be considered for silico-, bone, and meningeal tuberculosis.

Usual Adult Dose for Tuberculosis -- Prophylaxis:

300 mg orally once a day or 900 mg orally 2 to 3 times a week. Isoniazid should be continued for 6 months to prevent the development of active tuberculosis in patients with no complicating factors. Patients with complicating factors such as HIV infection, diabetes, hematologic malignancy, or scars on chest X-ray should receive prophylaxis for 12 months.


He already has to look forward to HIV Medication in the distant future.
please don't be so squeamish about taking some pills. Everybody takes meds, and as they get older most people take more and more. People with HIV aren't all that special. LOL

Besides, meds are NOT the enemy here. HIV and opportunistic infections are the enemies and could kill your boyfriend, while HIV meds and other prophylaxis will keep him healthy and able to live life to the fullest.  ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline nixsmail

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  • Posts: 73
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #7 on: November 29, 2012, 01:49:45 AM »
I wanted to take a minute to respond to a subject that's near to my heart but not dear.

i have had/have TB as well as it's closest relative MAC. it turns out that i had inactive TB infection with an active MAC infection. when first discovered was on an extreme pill regimen now only have to take two, ethanbutol and azithromycin, but probably for the same length of time i'll have to take my HIV meds, the rest of my life. the pills keep the TB inactive or latent so that it never reactivates which for us poz people could be deadly at a faster pace than a neg person.

i would suspect that since your bf is negative for TB at this time the prophylaxis would only be good for the time that he's on the pills and i would guess for a short time after. one course of six months i'm pretty sure will not provide rest of life protection against TB. i copied some info that i'll paste below as well as the link so that you can check it out. just my two cents worth cause it might at least be something that you could keep up on. take care of each other and be well.

"The medicine usually taken for the treatment of latent TB infection is called isoniazid (INH). Taken for 6 to 9 months, INH kills the TB bacteria that are in the body. If you take your medicine as instructed by your doctor or nurse, it can keep you from developing active TB disease. Children, adolescents, and HIV-infected persons with latent TB infection need to take INH for 9 months.

Because there are less bacteria, treatment for latent TB infection is much easier than treatment for TB disease. Usually, only one drug is needed to treat latent TB infection. A person with active TB disease has a large amount of TB bacteria in the body. Several drugs are needed to treat active TB disease.

Sometimes people are given treatment for latent TB infection even if their skin test reaction is negative. This is often done with infants, children, and HIV-infected persons who have recently spent time with someone with active TB disease. This is because they are at very high risk of developing active TB disease soon after they become infected with TB bacteria.
It is important that you take all the pills as prescribed. If you start taking INH, you will need to see your doctor or nurse on a regular schedule. The doctor or nurse will check on how you are doing. Some people have serious side effects from INH. If you have any of the following side effects, call your doctor or nurse right away:

•no appetite
•nausea
•vomiting
•yellowish skin or eyes
•fever for 3 or more days
•abdominal pain
•tingling in the fingers and toes
 
Warning: Frequent or heavy drinking of alcoholic beverages (wine, beer, and liquor) while taking INH can be dangerous. Check with your doctor or nurse for more information.

People who have latent TB infection need to know the symptoms of active TB disease. If they develop symptoms of active TB disease, they should see a doctor right away."


http://www.cdc.gov/tb/publications/faqs/qa_latenttbinf.htm#Latent4

ps - wouldn't worry about the cat, have had many animals, have one cat and one dog currently and have never had any issues with taking care of them and i really don't know what i'd do without them. just use common sense and you should be fine.
09/05/07 Officially diagnosed +4yrs at the time
11/06/07 CD4 624 (18%) VL 43,200
05/04/09 CD4 272 (15%) VL 521,190
06/10/09 CD4 127 (13%) VL 626,376 Started Truvada/Prezista/Norvir
07/15/09 CD4 849 (20%) VL 379
09/09/09 CD4 594 (21%) VL 68
01/28/10 CD4 706 (23%) VL 127
05/27/10 CD4 655 (22%) VL 322
07/29/10 CD4 750 (22%) VL 220
10/22/10 CD4 669 (23%) VL 65
12/27/10 CD4 720 (24%) VL 270
03/08/11 CD4 644 (23%) VL 631
07/27/11 CD4 694 (23%) VL <20
03/09/12 CD4 601 (20%) VL UND
11/07/12 CD4 693 (23%) VL UND
04/17/13 CD4 559 (23%) VL UND
11/07/13 CD4 846 (24%) VL UND
03/28/14 CD4 869 (24%) VL UND

Offline magnoman

  • Member
  • Posts: 26
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #8 on: November 29, 2012, 03:09:33 AM »
Thank you so much for sharing your experience nixsmail.

I had read quite a bit about Isoniazid before posting here, I think I might even have read the article you kindly linked to as well.

What I missed was the fact that Isoniazid is sometimes prescribed for people who are negative for Latent TB, especially those in high risk groups like infants, children if they had been exposed

I researched quite a bit about TB medication this morning before posting this and had read quite a lot about Isoniazid.

Rather like you I would be surprised if a course of Isoniazid would provide lifetime protection against TB, having said that I am told that TB is highly prevalent here, although I would have thought less so in the cities than out in the country.  What I am still unsure of is how likely it is that he could catch TB from his hospital visits, and general time out and about.  My limited understanding of it is that you are unlikely to catch it out and about and that is generally caught from someone you are in close continual contact with.

If it isn't too much trouble or too painful it would be interesting to hear how you think you caught it.

Thanks also Leatherman for this hugely important point to remember: "Besides, meds are NOT the enemy here. HIV and opportunistic infections are the enemies and could kill your boyfriend, while HIV meds and other prophylaxis will keep him healthy and able to live life to the fullest."

It is of course completely true and I apologize if I came across as overly squeamish!

Offline nixsmail

  • Member
  • Posts: 73
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #9 on: November 29, 2012, 11:27:10 PM »
no problem with the response, it's just that it's a pain in the ass having to take the extra pills for the rest of my life. but am taking the HIV meds anyway so as long as my body doesn't start doing anything strange i am going to be ok. that said my situation was as follows.

i work in a hospital but not in an area that is patient orientated. that is, my contact with patients is extremely limited and other than entering through the same door as the patients, i have little or nothing to do with them.

i'm in california and this part varies a little by state i think, but i would suppose that it's generally true. i'm required to test for TB every year because of working in the hospital (not anymore because once you have TB you will always test pos for it) and the test in Oct 2010 was administered and i really thought nothing of it but the next day had a raging itchy boil thing on my arm. went to the doc to have it checked and they immediately put me in a room where air only goes in not out. had to give sputum samples, get a blood check and wait for the docs. the docs told me to go straight home, no stopping no nothing and to stay there until the health department contacted me. they gave me my initial prescriptions (5) and was told to start taking them immediately.

the health dept showed up and interviewed me and we soon discovered that no one that i knew was sick or could possibly have given it to me. i was also required to stay at home under threat of arrest for not doing so, even if i wore a mask. the health dept said i could have simply been in contact with an individual at the grocery and if the droplets from their cough got into my system bingo.

the hospital also checked and they did not have any patients that they were aware of that could have given it either. so i really don't know who gave me the gift. but was off work from 10-7-10 to 2-14-11 and had to be cleared by the health dept and our employee heath and my doc before returning to work. they also started multiple people in my dept that i had close contact with but all tested neg.

turned out that the TB was inactive but the MAC was active and the treatment is almost identical. i lost 30 lbs from it and was starting to look like some of the first HIV victims almost like a walking skeleton. went from 168 to 134 almost in about 2 weeks.

so i would guess that being out and about, one would want to pay attention to someone who is coughing, which i would guess that most people dismiss almost immediately. i wouldn't get super paranoid about it and i would guess that as long as he's taking the drugs that would probably counteract the exposure. so sorry this got so long but it really was a pain and if only one person pays attention and possibly prevents themselves from acquiring it then it's worth it. hope all this helps. take care.
09/05/07 Officially diagnosed +4yrs at the time
11/06/07 CD4 624 (18%) VL 43,200
05/04/09 CD4 272 (15%) VL 521,190
06/10/09 CD4 127 (13%) VL 626,376 Started Truvada/Prezista/Norvir
07/15/09 CD4 849 (20%) VL 379
09/09/09 CD4 594 (21%) VL 68
01/28/10 CD4 706 (23%) VL 127
05/27/10 CD4 655 (22%) VL 322
07/29/10 CD4 750 (22%) VL 220
10/22/10 CD4 669 (23%) VL 65
12/27/10 CD4 720 (24%) VL 270
03/08/11 CD4 644 (23%) VL 631
07/27/11 CD4 694 (23%) VL <20
03/09/12 CD4 601 (20%) VL UND
11/07/12 CD4 693 (23%) VL UND
04/17/13 CD4 559 (23%) VL UND
11/07/13 CD4 846 (24%) VL UND
03/28/14 CD4 869 (24%) VL UND

Offline magnoman

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  • Posts: 26
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #10 on: December 01, 2012, 04:07:22 PM »
Thanks so much for the detailed reply.  Sounds like it almost certainly is a good idea for my bf to take the pills, despite currently being negative for TB.  Will just monitor for side effects.

I also found this article http://www.aidsmap.com/page/2456215/ which seemed to suggest that Isoniazid is effective and recommended for those already on Anti-Virals.

I'm yet to find much that recommends Isoniazid for those not yet on Anti-virals, but your experience and the fact that it is recommended by the doctors here does seem to me that it would make sense for my partner to take the medications.
« Last Edit: December 01, 2012, 07:44:26 PM by magnoman »

Offline Kitty K

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  • Posts: 1
Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #11 on: December 09, 2012, 11:52:30 PM »
Hi Magnoman,

I can fill you in a bit about the TB, Im a nurse specialist in Australia for TB.

The INH treatment for 6-9 months is to treat a Latent Infection (you have the bug in your body but you dont have active disease). When you say your partner tested negative, how did they test him? If it was a tuberculin skin test and it came back negative, it is quite unusual that they would give him prophylaxis. If they did a sputum sample or a Chest Xray, they were just checking for active disease.

INH prophylaxis will not give life long protection to TB and if you are living in a high burden country, there is good chance he may be exposed again after treatment ends.

You are right, you generally need a fair amount of close contact to a person with active disease to become infected, doesnt mean to say you couldnt be really unlucky out in public or in a work/school environment. It depends on the infectivity of the affected person (there are various degrees of infectiousness).

The BCG vaccination (TB vaccine) given in childhood has a very broad efficacy range. Here is Australia all our policies state that the range is between 0-80% so there is good chance that it has done little and will continue to provide little protection for your partner.

INH can have some nasty side effects for some people and you will need to pay close attention to his Liver Function Tests while is on it. Probably best to limit alcohol intake whilst he is on it too.

If over the course of years he develops symptoms (night sweats, weightloss, a cough that lasts longer than 2 weeks and/or he is coughing up blood) he should revisit his TB doctor.

In regards to the cat.... just make sure he washes his hands after he handles the kitty litter and he will be fine!

Hope this helps  ;)

KK
« Last Edit: December 10, 2012, 05:16:22 PM by Kitty K »

Offline magnoman

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Re: Looking for TB and Cat related advice for HIV+ partner
« Reply #12 on: December 21, 2012, 02:50:27 AM »
Thanks so much Kitty.

Apparently all the TB tests, sputum, xray and skin all came back as negative.

Supposedly the World Health Organisation recommend INH.  In this report, http://www.who.int/tb/challenges/hiv/tbhiv_brochure_singles.pdf, they state:

"Prevent TB. People living with HIV who are routinely exposed
to TB should be protected against becoming ill with TB. Such
protection is cheap and simple—a daily dose of isoniazid. By
end 2015, 30% of people living with HIV who do not have
active TB should receive this preventive treatment."

I guess that the levels of TB where we are in Latin America is sufficiently high to suggest that we are routinely exposed to TB.  All this reading is getting me neurotic and perhaps I should start taking it too!

We will just monitor it and hope he gets no side effects.  They don't seem to do any Liver Function tests at the moment, just a HIV blood test every 3 months.

We will keep an eye out for Isoniazid side effects and hope he doesn't suffer from any.

Again appreciate the response.  With regard to the cat litter, that now seems to have become my job! :(


 


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