pre meds condition worsens after meds

[nixsmail]

i'm new so don't be hard on me. i guess my question isn't so much about my meds but more about feeling powerless. i'll start at the beginning and try and be short. confirmed hiv+ 10-07 tcell 564 load 10k decided to postpone meds. sugery for tumor 12-07 fast forward to 04-09 started feeling overall itchy skin condition, not just moderate but driving force itchy particularly my scalp. prior to that my skin had been super oily all my life. tried eucerin and many other suggestions from almost anyone who would listen saw doc again 04-09 tcell 272 load 513k. my derm at the time wanted to try some drugs so we postponed meds. nothing the derm doc did helped reg doc gave me fluconazole and ketoconazole for possible fungus. no help. test again 06-09 tcell 172 load 623k started meds 6-10. truvada, norvir, and prezista no side affects but about 1 1/2 weeks after starting my skin went back to normal for about a week and has since progressed back to april conitions from there. pcp wants me to see a new derm doc but in the meantime any suggestions on decreasing the itchiness.

sorry to start my aidmeds experience with this but it's driving me nuts.

btw recent test 07-09 tcell 849 load 379 so the meds are working on the hiv but not helping with the other. my do said the rest of my blood work is normal.

[mecch]

Immune Restoration Syndrome, perhaps.
I had weird skin stuff first few months on HAART.  ID said it would all go away, and it did.

Good luck.

[BM]

Eosinophilic folliculitis? VERY itchy, and it requires a biopsy to be diagnosed. If you have little patches of red dots, it could be this, especially if your CD4 has been very low. I wasted a lot of time on a doctor who insisted I had seborrhoeic dermatitis, giving me all the treatments you mention, to no avail. Even if you don't have EF, you could give Zyrtec (cetirizine) a go. My dermatologist put me on twice the normal strength  - 20mg (2 tablets) per day, and all my itchy problems disappeared. When I stop the tablets, or take a lesser dose, the problems flare up again. Run the idea past your doctor and see what he thinks. It might also be worth trying a moderately strong topical steroid like Elocon.

Hope this helps.

[Giblarry]

Nix,

Does your regimen include Abacavir?  Look carefully, two or three combos contain it, like Epizicom. 

If you are taking it then you could be experiencing an allergic reaction to Abacavir.  Stop Abacavir and see your HIV specialist immediately.  This drug is not particularly dangerous unless you have a reaction ... then it can be fatal, and in pretty short order. 

If you are taking Abacavir, YOU DO NOT HAVE THE LUXURY OF PUTTING IT OFF!  STOP NOW! Don't restart the drug until you've seen your HIV spec. 

You could have folliculitis, but with your t-cells and low vl, it's not likely. 

Best of luck,
Gib

[Inchlingblue]

Does your regimen include Abacavir?  Look carefully, two or three combos contain it, like Epizicom.  
 

He said he's taking Prezista/Norvir/Truvada so it's not abacavir hypersensitivity.

Always good to cross that one off of possible culprits list.

[Tempeboy]

Hey Nixmail,

Are you taking any other medication or supplements?  Do you have any allergies?

[mecch]

antihistimines, aslo, yeah, helped me, and the other poster. try that.

[nixsmail]

thanks for all the responses a hug for all of you.

i will check out the eosiophilic folliculitis tomorrow first thing and the new derm doc may have some path to go but at this point i'm about ready to start asking about a skin transplant at least for my head anyway. thanks for the suggestion.

i've taken antihistamines and nothing.

no other current medication except the hiv meds, am taking a supplement for essential fatty acids, the omega stuff. no known allergies to anything. but i have one weird connection with pain medication, vicadin, percocet, etc  in their normal doses have never worked for me. past experience double doses do about half of the expected result. but that experience has only be with pain meds. antibiotics etc have in the past worked fine. and yes my pcp doc knows all this.

anyway any other suggestions will be checked out until it gets better or i get a skin transplant, HA. thanks again everyone.

[mecch]

http://well.blogs.nytimes.com/2009/08/06/the-pain-of-being-a-redhead/?em

Are you a redhead? Redheads, and small number of other people have a genetic mutation that interferes with pain killers.

[Giblarry]

He said he's taking Prezista/Norvir/Truvada so it's not abacavir hypersensitivity.

Always good to cross that one off of possible culprits list.

Thanks Inch for pointing that out.  I hear about itchy reactions and immediately panic.  I've seen what a bad reaction can do. 

Thanks again,
Gib

[Inchlingblue]

Thanks Inch for pointing that out.  I hear about itchy reactions and immediately panic.  I've seen what a bad reaction can do.  

Thanks again,
Gib

It's totally understandable.  The scary thing is that there are doctors out there who put people on abacavir/ziagen without doing the test first, it does happen. There's a thread called "Starting Trizivir" where that came up. You'd think this was basic for anyone treating HIV.

[risred1]

with HIV, I tended to get some small red "dots" blotches, about the size of a pimple on my chest....

As my CD4 dropped, I would have episodes, where they would even spread on my neck and the side of my face.

I treated with Hydro Cortisone as that seemed to do the trick.

After I started meds, Everything was clear and then it started up again, and my doctor even made note of it. It could be a fungal infection, dermatitis.... they won't know until tests are done.

But since then, they have pretty much vanished.

My doctor did note that if it was fungal or some type of skin infection, that the body will try to fight these off. As my health improved on the meds, perhaps my body was able to surpress these little outbreaks.

Creams like Hydro Cortisone may help better than a moisturizer, as it is an anti inflammatory. Or if it is fungal, Lamisil cream often is utilized. But these determinations are usually done after a scraping at least and microscopic examination or examination of the skin under a magnifier.

I've always been a bit prone to fungal infections, so I've been through the routine several times.

Either way, we are just speculating. If they cleared up, great! but if they come back, best to get a dermatologist involved who works with poz folks.

[texfire]

Hi,

Not sure if your condition cleared up, but another thing to consider is DEMODEX FOLLICULITIS.
Basically, it is the regular hair mites we all have get super excited, colonize sweat glands and follicles in the forehead, and cause a rash.  Typically, it is face, around forehead but apparently can get down to chest hairs and so forth.   Typically reddish rash with lots of smaller pimple looking pustules and they either itch or feel raw. It seems to increase in predilection with age and immunostatus.

In my case, I lived with this for years...rash would come up after an hour of sweating from excercise or being outside.  By that night it'd have started and looked horrible.  Finally found a dermatologist yesterday who thought of it.  Poked the little pimples, put the pus on a slide, and I got to see my own parasites under the microscope.  On one oral med and one topical med, both outrageously expensive.

Anyways, another thing to think about,

texfire

[macaque3]

Hey Nixsmail,
I'm sorry to hear about your dermatologic misfortunes. Has it changed at this point? Had youseen a second derm doctor? I was diaganosed in May (acute infxn) and started treatment immediately, and had to go off AtrIPLA for liver enzyme elevation. Then tried Raltegravir + Truvada. I have had psoriasis since childhood, and was told this can get worse (or come back) with HIV. Had some scrotal rash, before starting the second cocktail, but this got unbearable while I was on vacation, saw a derm doctor in germany, and had to stop the cocktail. It could have been trazodone which kicked it off (i started that 2 weeks before raltegravir), but i was spooked by the terrible rash and quit. I'd never had any adverse effects to meds til these too, and havebeen pretty demoralized by it. It seemed your numbers justified being on meds... have you felt otherwise OK?
I'm sorry for your troubles. However it is somehow a relief to know i've not been the only one with these diffictulties at the start of therapy.
Best of luck, let me know what happens with the skin stuff!
larry