I am 35 years old and HIV-positive. I have been experiencing hot flashes at night for the past year. Is there anything I can do to help me sleep through the night and stop this? My doctor checked my hormone level and says it does not seem premenopausal. Help! I need to sleep!

P.

Hot flashes are a symptom that can be very difficult to diagnose, especially in HIV infection. It was a good idea to check your hormone levels, as HIV can cause hormonal problems by affecting the adrenal glands. These glands produce hormones that control weight gain, energy, blood pressure and several other important functions in the body. HIV can also affect the sex hormones, particularly testosterone in men.

I would also want to know how advanced your HIV disease is -- especially your T-cell count and viral load. The T-cell count tells us if you are currently at risk of various infections. The viral load, a measure of the amount of HIV in your blood, tells us how fast your disease may progress. If your T-cell count is very high and your viral load is very low, then your hot flashes are not likely to be related to your HIV, and I would look for signs not only of menopause but also of other female hormone imbalance, thyroid hormone imbalance, medication toxicity and a large variety of other conditions.

If your HIV is more advanced, then other causes of hot flashes are more likely. You will need a thorough history and physical exam, as well as many other tests, to pinpoint the cause. For example, people with HIV infection often experience so-called "constitutional symptoms" such as hot flashes, sweats and low-grade fevers. If you have these other symptoms, the cause may be HIV itself. Another possible cause is a bacterial infection, such as tuberculosis and a similar infection called MAI. Viruses such as CMV and hepatitis may also be to blame. In rare cases, tumors such as lymphoma and Kaposi's sarcoma can develop, sometimes causing fever. All of these disorders tend to occur in those with more advanced HIV disease, and all have other signs of illness, such as swollen lymph nodes.

You mention that you have trouble sleeping because of the hot flashes. In that case, your symptom may be related to a medicine you are taking at bedtime. Niacin is the most common medication to cause flushing, but others, including some HIV medicines, can do it as well.

I suggest you discuss your illness in detail with your physician. Make sure you are well-versed in your disease, especially your T-cell count and viral load. Also, make sure your doctor has fully examined you and knows about all of your symptoms. With all of the information at hand, your doctor should be able to help you get rid of the flashes, perhaps by prescribing a so-called drug "cocktail," a combination of several antiviral drugs that can reduce the viral load and treat the constitutional symptoms of HIV infection.