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New Diagnosis, Extremely Low CD4 count
May 7, 2008

My husband was just diagnosed as HIV pos when he was admitted to the hospital with an extremely aggressive pneumonia. Other than this event (and Fournier's gangrene 2.5 yrs ago, when no HIV testing was done), he has been very healthy, with NO symptoms of HIV, yet his CD4 count was 30?!?! The doctors haven't said he has AIDS, seem to have no qualms about discharging him with such a low count, and are telling us that HIV is very treatable. They have been unable to determine if this pneumonia was PCP, and he is recovering with almost miraculous speed.

All the info I've read so far indicates that such a low count means he's had HIV for a long time. He is 45, has never engaged in any high risk behaviours, and to say this diagnosis blindsided us would be an understatement!

Can you give me an idea of the likelihood of his responding well to HAART treatment?

Response from Dr. Moyle

Sorry to hear about what has happened to your husband. CD4 counts below 200 are considered by the U.S. CDC to be "AIDS-defining." This is largely a definition for purposes of access to care in the US and is not used to define AIDS elsewhere. As we now see HIV as a chronic manageable disease, the defining of whether some has had an AIDS-defining event is not seen as being so important; it is response to treatment that matters. CD4 numbers at presentation don't say anything about how long the infection has been about. Some people lose CD4s very slowly, others quickly. Older people (>40!) and people who start with lower CD4s tend not to have CD4 numbers recover so fast and to such as high a level as younger folks starting at higher CD4 counts. However, CD4 counts should recover well over time, and your husband's immune system will return to an adequate level. Whether people with low CD4 respond less well to medication is a bit controversial. My read of the data is that well chosen combinations like the ones recommended in international guidelines all work well in persons with low CD4, but people with low CD4s tend to get more side effects than average when they start, so they may need to adjust meds more often before they settle into therapy.

Now that your husband is over his pneumonia he can get started with meds. The first few months will be a bit tough, but within 6 months he should be back on top.

Best Of Luck

Dr. Moyle



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