Persistent fever with CD4 of 330.

[rajan.td]

Sir,
A case of HIV, CD4 count 330, presented with repeated minor pyoderma on skin. Skin condition cleared but now presents with persistent fever. Fever remits with Paracetamol taken thrice daily. No infective focus found on XRay chest. CBC ESR normal. Patient in sound general health but for the fever. Fever persists even after 2 weeks of ZDV, 3TC, NVP initiated. How long should one wait to see if the ART is controlling the fever? Does it suggest a change in ART drugs? What is the further management?
Regds
RTD

[rejikoshy]

HIV perse as a cause of Fever is very unlikely .It would be best to rule out TB(occult) by asking first for a CT Scan Chest with contrast or a USG Scan of the Abdomen with special High frequency scanning of the spleen to rule out splenic abscesses.

[rajan.td]

Thank you, sir. The patient did not favour undergoing more investigations for financial reasons. Fortunately at the end of the month fever had completely subsided. Appetite had improved and he was back to work with increased vigour.
Thanks once again.
Regds
RTD