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viral load undetectable still CD4 low
Jan 21, 2004

My recent lab test revealed that my viral load has become undetectable but my CD4 count is still very low, 89.How is this possible? I'm on AZT,3TC and Crixivan and have HIV-Hepatitis B coinfection.Thanks for the encouragement and support you are giving to the unfortunate.

Response from Dr. Frascino

Hello,

The CD4 cell count is a measure of your immune system's health. The viral load measures the amount of new HIV produced and released into your bloodstream. In general, the higher the viral load, the faster the disease is progressing and this is often reflected in a falling CD4 cell count. However, the relationship between viral load and CD4 counts is still not well understood. These are two very different tests measuring two very different parameters. CD4 cells are involved in many immune functions in addition to battling HIV, and consequently, you may not see the expected "see-saw" relationship between CD4 and viral load. You, for instance, have both HIV and Hep B. CD4 cells will be involved battling both of these infections. The important and encouraging thing in your specific case is that your current HIV therapy is working well. Suppressing the viral load to undetectable levels is the best thing you can do to allow your immune system to recuperate from HIV's onslaught. The longer your viral load stays undetectable, the better chance you'll have for immune reconstitution (increased CD4 cells).

If your viral load has only recently become undetectable, give it some time. Your CD4s should start to climb. With CD4s less than 200, remember you'll need prophylaxis for PCP (Bactrim) and to be monitored for other potential opportunistic infections. However, at this point, you have good reason to feel optimistic that things are heading (or soon will be) in the right direction.

Dr. Bob


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