Managing Anxiety and Health Concerns for HIV Positive Patients

Q: Managing Anxiety and Health Concerns for HIV Positive Patients

Hello： <br>1. <br>If your HIV is well-controlled with medication (which should be the case, as your viral load remains undetectable), having a CD4 count of 500-700 means your immune system is not significantly worse than that of the general population. <br>It is reasonable to see

The issue of experiencing anxiety and discomfort for an entire year?

Hello, doctor.
After many years of using Google for medical inquiries, this is my first time asking a question on this platform.
I am HIV positive and have been on medication for five years, with my viral load consistently undetectable.
My CD4 count fluctuates between 500 and 700.
Since the outbreak of COVID-19 in early 2020, I have been extremely worried about my survival due to my compromised immune system.
I have also been experiencing recurrent flu-like symptoms, and my anxiety reached a critical point, leading to a diagnosis of panic disorder for which I received medication treatment for a while.

I understand that the current criteria for potential COVID-19 infection are based on travel and exposure history, but my low immunity keeps me in a state of constant anxiety.
On January 18, 2021, I experienced a sore throat and initially did not think much of it, so I visited a general clinic.
The next day, January 19, I woke up with less throat pain, but it was still swollen.
Subsequently, I developed muscle aches all over my body and suspected it might be the flu, so I went to the family medicine department at Tainan CM Hospital.
The doctor ordered blood tests, which showed no abnormalities in my white blood cell count, and he concluded it was just a common cold, advising me to rest.
I would like to ask the following questions:
1.
Given that individuals with lower CD4 counts have a diminished immune response, such as fever, is it possible that their immune reactions are worse than those of the general population? Should I seek medical attention for minor symptoms? I have not experienced a high fever (over 38°C) since starting treatment, although I used to be prone to fevers, which makes me fearful that a common cold could escalate into a serious illness for me.

2.
I found online that if an HIV-positive individual exhibits flu-like symptoms, they can be prescribed antiviral medication like oseltamivir (Tamiflu) directly.
In 2020, a doctor prescribed it for me without a rapid test, but in 2021, this was not the case.
If it were indeed the flu, is there a risk of developing severe complications?
3.
Does this ongoing anxiety affect my CD4 count? My CD4 count dropped from over 700, close to 800 at the beginning of 2020, to only 500 by the end of the year, and I cannot identify any other issues aside from my panic and anxiety.

MW, 20~29 year old female. Ask Date: 2021/01/19

Dr. Lin Wufu reply Internal Medicine

Hello:
1.
If your HIV is well-controlled with medication (which should be the case, as your viral load remains undetectable), having a CD4 count of 500-700 means your immune system is not significantly worse than that of the general population.
It is reasonable to seek medical attention if you experience any health issues, but you shouldn't overly worry about contracting different or more severe illnesses than others.

2.
Currently, there is no literature indicating that HIV patients have a significantly increased risk of developing severe complications from influenza.
I believe you haven't been tested this year because, due to the pandemic, everyone has been wearing masks, and so far, the nationwide influenza activity has been very mild.
Therefore, it hasn't reached the point where doctors suspect influenza at the mere onset of cold symptoms.
However, if your sore throat or muscle aches persist, you should return for further evaluation.
3.
CD4 counts naturally fluctuate and are influenced by stress, lifestyle, and other chronic conditions.
As long as your viral load remains undetectable, it is usually acceptable to monitor the situation or consider adjusting your lifestyle and increasing your physical activity, which may be beneficial.

Reply Date: 2021/01/19

More Info

Managing anxiety and health concerns for HIV positive patients, especially during challenging times like the COVID-19 pandemic, is crucial for both mental and physical well-being. As an HIV positive individual who has been on antiretroviral therapy (ART) for five years, it’s understandable to have heightened concerns about health, particularly with a fluctuating CD4 count and the fear of infections.

1. Immune Response and Symptoms: It is true that individuals with HIV, particularly those with lower CD4 counts, may have a compromised immune response. However, your CD4 count of 500-700 is generally considered to be within a range that allows for a relatively normal immune function. While it’s reasonable to be vigilant about health changes, not every minor symptom necessitates immediate medical attention. It’s important to differentiate between what constitutes a significant change in health status versus normal fluctuations. If you experience persistent symptoms or if they worsen, seeking medical advice is prudent. Your previous experiences with fever and infections may have heightened your anxiety, but it’s essential to remember that not every cold or flu will lead to severe complications.

2. Influenza and Treatment: Regarding the treatment for flu-like symptoms, it’s important to note that the decision to prescribe antiviral medications like oseltamivir (Tamiflu) is often based on clinical judgment and the current epidemiological context. If flu is circulating widely, doctors may be more inclined to prescribe antivirals. However, if the flu season is mild or if your symptoms are not severe, they may opt for a more conservative approach. The risk of severe complications from influenza in HIV positive patients is not significantly higher than in the general population, especially if your viral load is undetectable and your CD4 count is stable. Nonetheless, if you have concerns about your symptoms, it’s always best to consult with your healthcare provider.

3. Impact of Anxiety on CD4 Count: Chronic anxiety and stress can indeed have physiological effects on the body, including the immune system. Stress can lead to increased levels of cortisol, which may negatively impact immune function and potentially influence CD4 counts. Your observation of a drop in your CD4 count from 700 to 500 could be related to various factors, including stress, lifestyle changes, or even the natural variability of CD4 counts over time. It’s crucial to address anxiety through appropriate channels, such as therapy or medication, as managing your mental health can have a positive impact on your overall health, including your immune system.

In summary, while it’s natural to have concerns about your health as an HIV positive individual, especially during a pandemic, it’s essential to maintain a balanced perspective. Regular communication with your healthcare provider, adherence to your ART regimen, and proactive management of anxiety through therapy or support groups can significantly improve your quality of life. Remember, you are not alone in this journey, and there are resources available to help you navigate these challenges.

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