Dearest Dr. Bob,

I thank you from the bottom of my heart for your great work herein. I, one of your many fans, have a question concerning my Cd-4 count. I began HAART at the beginning of March with a Cd-4 count of 67 and a viral load in excess of 800,000. Since beginning a Sustiva, Epzicom, and Bactrim regimen my numbers have improved. My 12 week check showed my Cd-4 at 195 and my V.L. to be 110. Great huh? Then yesterday my results came back Cd-4 192 and my viral load less than 50. I call my Cd-4's my little soldiers and I am concerned over the loss of even 3 of them. Is this unfounded? Furthermore, is there anything that I can do to aid in pushing the cd-4 count higher. I eat well, exercise, stay active and happy (most of the time). I just needed your expert advice. Thanks a million!!!

Hello,

Yes, overall your response to therapy has been quite good. Virologically your HIV viral load has plummeted from over 800,000 to undetectable within six months. Immunologically your CD4 count has improved from 67 to the mid 190's. There is some variability in the absolute CD4 cell count number. Statistically you really haven't lost any of your little soldiers. The 195 and 192 are essentially the same. Hopefully with time and with keeping your viral load suppressed to undetectable levels, you should see additional immune reconstitution, i.e. further increases in your absolute CD4 cell count and CD4%.

As for pushing your CD4 count higher, I believe you're on the right track: optimize your nutrition and exercise programs, get adequate sleep, decrease stress, adhere to your medication schedule, etc. If your CD4 soldiers are still not recruiting additional troops, you might consider trying a protease inhibitor-based regimen, such as Kaletra plus Truvada (FTC + Viread).

Good luck. Stay well.

Dr. Bob