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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Fever, taking Augmentin. History of kidney problems and ulcerative colitis. Does his ART need to change?

Good morning Dr 1. In 2009 my father was having some problem related to kidney and his cretanine levels were diagnosed at 1.5... now they remain between 1.5-1.9 2. He was also diagnosed with Ulcerous Colitis in 2010 3. My father was then diagnosed HIV-2 in June 2011 at a stage when his CD4 dropped to 84. He had had no such problem before that, hence diagnosis never happened. He underwent blood transfusion in 1989, and that could be the cause of the same. 4. He was put on ART - Tavin-EM and Atenazor-R from then and continues 5. His CD4 has now increased to 288 6. But for the last 23 days he is running continuous fever, had very bad cough 7. TB (AFB) test is negative, Chest X-Ray is clear, HRCT Thoraic was also not conclusive, hence TB for now has been kind of ruled out 8. His hemoglobin has been dropping and is now at 8.9, RBC has also dropped, Monocytes have increased to 12.7%, CD4 has also dropped to 244 9. Blood culture interim report is normal, final report will come tomorrow 10. Creatinine level is 1.7, LFT - Bilirubin is 1.5 11. When the fever started, he was put on Azithral for 5-days, then later the antibiotic was changed to Ofloxacin for 7-days. But fever persisted and remained at 100-101 levels 12. Then all antibiotics were stopped, and regular test have been conducted but NO FINAL DIAGNOSIS HAS HAPPENED 13. Now for the last 2-days he has been put on Augmentin, fever has increased to 103.4 this morning I wanted to know know what should we do in such a case. Does his ART need to change ? Is the antibiotic he is taking fine ? Any other tests that need to be conducted ?
Thu, 26 Dec 2013
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Infectious Diseases Specialist 's  Response
Welcome to HCM.

HIV positive individuals with low CD4 count are prone for many opportunistic infections He seems to be suffering from bacteremia and the organism seems to be multidrug resistant as he is not responding to many antibiotics prescribed to him. I suggest you wait for the final blood culture report and let his treating doctor decide the antibiotic to be given to him based on the report. Augmentin is a broad spectrum antibiotic and will be able to control the infection in most cases.
His CD4 count is improving, so his ART seems to be working for him. I suggest you make him as comfortable as possible and try increasing the dosage of his fever medications after consultation with his doctor.
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