Q-A 1

Q (t) May I ask you some technical questions for a patient who is a friend of mine ?

This friend is followed-up in a little city near Toulouse. He was prescribed the tritherapy that appears to be the less interesting (Crixivan + Retrovir + Vides). I advised him to consult another hospital. Would you have in this region a contact more adapted to our wishes ?

What more, we won't have the result of the viral load before 6 weeks. Do you know any others analysis, easier, more economic and more accessible, that would allow to evaluate the response to a treatment ?

Which exam do you recommend for a patient who is Toxoplasmosis and CMV positive, apart from a cerebral scanner of a therapeutic proof ?

This patient is thirty year old, and has been tested seropositive three years ago. The origin of his contamination is unknow. His state deteriorated since the beginning of this year, the contamination should have occured in 85-86. He had a whopping cough that degenerated into a pneumocystosis. He has been well cured, he took 4 kilos, but his T4 cells fell to 60-70. As I told you, the best tritherapy hasn't been chosen.

We can ask a radiesthesist to test the medicines, it is difficult to chose strategy. Your suggestions will be well accepted. Thank you in advance.

A (t) We have no specific contact in the region of Toulouse. You could try to ask the Association Diagonale (18, rue des 7 Troubadours, 31000 Toulouse). They may help you.

Concerning the biological evaluation of the effect of an anti-HIV treatment, there is no 100% reliable tracer. Initially, the CD4 cell count was the mainly used measure (the most reliable value being the absolute value per mm3, and mostly the percentage value). Any important modification of the T4 cell count must be confirmed by another analysis. Some recommend to associate the total lymphocyte count with triglycerides. Studies have shown that the reliability of the T4 cell count is higher, as there is an agreement with these two other tracers : thus when T4 cells are > 200/mm3, total lymphocytes are > 1,000/mm3, and triglycerides under 2.5 g/l and inversely; concerning the viral load, this test is complementary to the T4 cell count, but is unfortunately not much used, in town or at the hospital. Some hospital limit its prescription because of its high cost, and some analysis laboratories do not give to the patients the possibility to be reimbursed. Now, in town, it can be taken in acceptance by the social security, for the following wording is used : HIV culture for the therapeutical follow-up and viral load (for more precisions, particularly for a person living in province desiring to make this analysis, contact from us Dr LY, Institut Fournier, 25 bd St Jacques, 75680 Paris cedex 14; Tel : +33 (0)1 40 78 26 00)

Concerning CMV, the serology is indeed often positive. This serology attests the presence of antibodies, as soon as a person has been in contact with the CMV, whether this person had an apparent CMV affection, or most of the time, inapparent, which is the case for 50 to 60% of the population, and for 90 to 95% of the homosexuals. This serology has no interest for a HIV+ patient, to appreciate the risk of a clinical CMV infection, particularly a retinitis. This risk is very rare when the CD4 cells are higher than 100/mm3, but becomes frequent when inferior to 50/mm3. Fundus oculi test must be regularly carried out under 100/mm3 (every 3 months, and every month when under than 50/mm3). The CMV viral load is another important analysis. It consists in proving the presence of the virus in the blood by culturing cells. When positive, there is a probability of 50 % that the patient will make, under 6 month, a clinical CMV infection (retinitis or, more rarely, digestive, pulmonary, or neurologic). Two positive viremias sign at 50 % (according to other authors, 100%) the apparition of a clinical CMV infection under three months; in that case preventive treatments are inefficient. It is recommended to consult in emergency, if CD4 cells are under 50/mm3, for any view problem. The measurement of the virus in the urine is sometimes used, but difficult to interpret.

If you wish to have more precisions concerning the CMV, you should contact Serge LECOZ, scientific coordinator of the journal Info Treatments (several articles are concerning the CMV, particularly its preventive and curative treatment) from the Actions Traitements Association (190 bd de Charonne, 75020 Paris, France; Tel +33 (0)1 43 67 66 00).

Concerning the tests evaluating the risk of toxoplasmosis, means are limited to the detection of the least clinical, neurological or psychiatric sign (it may be a commun sign, such as headache, loss of motivity or sensitivity, blindness, personality troubles, confusion, disorientation, either coma), that must lead to make a scanner or a MRI before 48 hrs. The risk is usually more frequent for patients that do not follow a preventive treatment, and whose CD4 cells are under 200/mm3 or 15 %. If CD4 cells are under these values, this prophylaxy is recommended, with Bactrim (1 tablet a day), generaly well tolerated (in case of allergy, a desensibilisation is possible), allowing also a primary or secondary pneumocystosis prevention.

Concerning the use of radiesthesy to test the most adapted medicine for a particular patient, we have no answer elements.

We have published on our website <http://www.positifs.org/> a text (C.30) in wich we mention the Mora system that would allow to detect the molecules toxicity for each patient. (9709)