I Got TB

Six months before I found out I'm positive, I was diagnosed with TB adenitis. It started with a persistent dry cough that has not been going for a month. I went to several doctors, and took different antibiotics. But the dry cough didn't resolve. I even had high fever one time. The fever went away, but the cough persisted. One day, I noticed a lymph node on my neck. I was a bit paranoid, so I immediately consulted an EENT. He said it was an infection. I asked what caused the infection. He just said, many factors. He didn't like to expound, so I stopped asking. He prescribed antibiotics. But the lymph node didn't heal. It got even bigger. After three weeks, my doctor asked me to have a CT scan then recommended an Incision & Drainage procedure, a minor outpatient surgery to remove the abscess that was causing the swelling of the lymph node. I got scared, coz that was the first time I was put in an operating room. The procedure took only 45 minutes. Then, I said, finally... it's done. This lymph node is gone. I then had breakfast in a nearby restaurant right after the surgery, then went home. 

After 2 weeks, I noticed the wound was not healing, and there were still a few small nodes that can only be noticed when touched. I tried to go back to my EENT, but he was on a long vacation. I went to another EENT accredited by my HMO. He examined if I had polyps in my nose, then advised me also to go to a pulmonologist. He said that lymph nodes are sometimes caused by TB, so I better see a pulmonologist. So I saw a pulmonologist. I had my X-ray done. I tried to read about TB. What I read scared me. TB on the lymph node (also called extra-pulmonary TB or ePTB, or TB adenitis) is caused by the same bacteria that is causing TB in the lungs. But only people with low immune system are the ones that normally get ePTB. In some countries, it is common practice by doctors to advise patients with ePTB to also undergo HIV testing. With this knowledge, I saw my pulmonologist, hoping that he wouldn't ask me to have an HIV testing. I had my HIV testing in 2006, and God knows how scared and stressed I was while waiting for the result. It was a week of sleepless nights because during that time, HIV test result takes one week to come out. I didn’t know if I have the courage to go through that ordeal once more.

So, I saw my pulmonologist. He asked me to have my X-ray and PDP skin test, and fortunately (I thought), he didn’t ask for an HIV test. My X-ray result came out. PDP skin test showed positive result, but my lungs were cleared from any infection based on the X-ray. So, my pulmo concluded that I didn’t have a pulmonary TB, but I had an ePTB. At the back of my mind, I knew I could be HIV infected, but I didn’t discuss it with my pulmo. Then, my first EENT came back from his long vacation. As a courtesy, I showed him my PDP test and X-ray result, and told him that I’m already seeing a pulmonologist who diagnosed my illness as ePTB. My EENT said it was most likely TB. He also advised me to see an Infection Disease Specialist. I told him, I already have a pulmo who is treating my TB. He said I should still see an IDS for second opinion. Hey, the sound of Infection Disease scared me so much! I haven’t heard such a medical specialization before. Do they specialize in HIV? I feared that if I went to an IDS, he/she would definitely ask for an HIV test.

So, I just consulted my pulmo, and never saw an IDS. I thought a pulmo is also a medical doctor anyway. And my pulmo assured me that whether it’s pulmonary or ePTB, the medication is the same. I was prescribed with 4 tablets of Quadtab (a combination of 4 antibiotics in one tablet) which I had to take for 2 months. After that, he would change my antibiotics to 2 tablets of Rimactazid (a combination of 2 antibiotics) which I have to take for another 4 months. Wow, TB treatment will take 6 months long! One good news though was I didn’t have to stop working since ePTB is non-contagious. At this time, I was already losing some weight, which my pulmo also attributed to my TB.

Ok, I took my medicines religiously. After 2 months, my lymph nodes were all gone, and the surgery incision healed. I started to work out again at Fitness First. Finally, after months of TB medication, I’m gonna have my life back. In a few months, I can go to the bars again and drink. I looked forward to be sick-free and be normal again. I already started going to the gym. I started going to a bar, without drinking alcohol. I even went to a beach with my friends for summer. Yes, I’m having a normal life again! Until one day....

My Quick Story

HIV is not a death sentence. It is definitely survivable. If I survived it, others can as well! 

I'll try to share my HIV story in this post as short as possible. I will detail each episode of my HIV-related illnesses in my next posts. 

Early this year, I was diagnosed with TB adenitis, or swelling of lymph nodes caused by the tuberculosis bacteria. Yes, It's the same TB bacteria that causes the common pulmonary TB. Since it is extra pulmonary (occurring outside the lungs), it is a first sign of HIV, because people with normal immune system could easily fight off this bacteria. But I shrugged off this early sign of HIV, and tried to believe that I am negative from the dreaded disease. I took my TB antibiotics and had an outpatient surgery to remove the abscess-filled lymph nodes caused by TB. Fast forward, my lymph nodes were removed and I thought everything was resolved. 

Two months after the surgery, I resumed my workout at the gym. Then, I started to notice shortness of breath. This condition got worse each week. My pulmonologist diagnosed it as asthma. When shortness of breath became unbearable, my doctor ordered me to be admitted in a hospital. I was discharged after a week for supposedly acute asthma and community-acquired pneumonia. I continued oral meds at home for pneumonia, but my breathing did not improve. It was even worsening. I went back to my doctor, so he ordered me to have a sputum test to check if my pneumonia was caused by the PCP fungus. I started to research about pneumonia since I know that it is a common infection of people living with HIV (PLHIV). Based on my readings, I found out that for my age profile, if I had PCP, I would most likely be HIV positive. My breathing continued to get worse, until it became unbearable. I was grasping for air even when I walk just 10 steps from my room. I was admitted again in the same hospital. I was already expecting the worst - that I would now be diagnosed as HIV positive. While in the hospital, the sad news came in. I was positive for PCP, which was synonymous to confirming that I was HIV positive. I told this to my 2 closed friends and immediate family the day after. Then my HMO came in saying they can no longer shoulder my hospitalization. Since my hospital bill was getting high, I transferred to a private room at PGH. At PGH, I had my HIV and CD4 tests. After another week of hospital treatment, my breathing significantly improved. So I was discharged and continued oral meds at home.  HIV confirmation and CD4 tests came out. Yes, I was positive for HIV-1, and my CD4 was very low at 15. I was advised to start HIV treatment (the anti-retroviral drugs, sometimes called ART, ARV or HAART) to repair my severely damaged immune system. As you know, ARV has  several side effects especially during the first 2 weeks. 

Incidentally, a few hours before I took my first dose of ARV, I had a headache and slight fever. I took paracetamol and then started my first dose of ARV. The following day, my condition started to get worse. I had nausea and vomited whatever I ate. I went back to my doctor for checkup 4 days after my first ARV. She wanted to confine me again to monitor my condition. Then, test results came out. I had cryptococcal meningitis. Like PCP, this type of meningitis is a major AIDS-defining illness - meaning AIDS patients are the only ones that get this type of infection. Medicines for crypto are very expensive, about 6,000 per day for 2 weeks and are quite toxic. It caused me nausea, vomiting, fever and chills immediately after the infusion of the IV. And it burned my veins, such that they had to change my IV line every other day. This went on for 2-3 weeks. And on my 4th week in the hospital, I finally got better. No more nausea, vomiting, headache and fever. So, I was discharged and continued crypto medication with oral meds at home. Oral meds were still expensive. I had to take four 200 mg of fluconazole each day for two months (Pfizer: Php 800 per tablet, Unilab: 320 per tablet). Good thing, Pfizer's price at PGH pharmacy is discounted at only 300 per tablet. 

With continued oral medicines for TB and meningitis, prophylaxis for pneumonia, and HIV ARV drugs, I continued to get better at home. I felt it... I was getting better. I was overcoming all these opportunistic infections. I started to do push-ups and squats at home, but still avoided going out. Then a month after, I had skin problems. I had acne vulgaris (pimple eruptions) all over my face, dermatitis on my chest, and folliculitis on my arms and legs. I also had eczema on my arms. I consulted a dermatologist. With various skin creams and lotions that she prescribed, my skin problems resolved. 

I went back to PGH-SAGIP for my regular checkup with my HIV doctor. She ordered that I get another CD4 test and various blood tests. Test results came in. All my blood tests were good. X-ray showed that my pneumonia cleared up. And, three months after taking my ARV, my CD4 increased from 15 to 90. Now, I continue to get well, and I am hoping that in another 3 months, my CD4 would go beyond 200 so I could already discontinue my prophylaxis medicines. 6 months since my initial hospitalization for supposedly "asthma," I went back to work. 

With positive outlook, 100% adherence to all medicines, appropriate diet and nutrition, HIV even at an advanced stage is very much survivable. HIV today is not anymore the HIV disease that was in the 80's and early 90's. Yes, there is still no cure for HIV, but there are medicines that help PLHIV get well. As my doctor put it, HIV is now like diabetes and hypertension - no cure for them, but I need lifetime medication that can help me live a normal life.