Hi there Dr. Bob. Thank you for all the great work you do, and for your hilarious sense of humor.

I have a few questions. I have been positive for 10 years and have been of an on meds with no resistance. I am currently on epivir viramune and zerit, have been for a year, and have been undetectable for a year. While I am happy to report that I am undetectable for 8 months, and my t-cells are at 900, I am worried that over the years my percentage seems to be stuck in the low 20's, and does not want to budge. I should not that I contracted herpes in 2005 but take meds for that and I do not suffer from frequent outbreaks. I also have year-round allergies and wonder if that is keeping the percentage down.

My doctor tells me not to worry over the percentage because my t-cells are high and my white blood cells are "normal," that is, in the normal range.

Your thoughts on my situation? Thanks so much!

Hi,

It's difficult for me to comment without being able to see all your laboratory results and T-cell subsets analyses. Perennial allergies would not affect your CD4%.

In general I understand your HIV specialist's assessment. However, I do have some reservations about your current combination antiretroviral regimen; in particular, Zerit. This thymidine analog reverse transcriptase inhibitor (wow, that's a mouthful, isn't it?) has been linked to undesirable side effects and toxicities, including lipoatrophy (loss of fat in the face, buttocks and extremities). There are certainly much better options available now. Perhaps your HIV specialist would consider a switch to one of the newer (and preferred) regimens. This might also goose up your CD4%.

Good luck.

Dr. Bob