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Fatigue and AnemiaFatigue and Anemia
          
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Thank you for the DVD....will make another donation
Aug 3, 2011

Dr. Frascino,

Thank you for the note and DVD I just received. I enjoyed viewing it just now.

I've writeen you a few times before and you have kindly answered and I greatly appreciate it and will make another donation.

To refresh your memory, I was hospitalized in Mar/Apr of 08 for a month with PCP Pnuemonia, Diseminated Histoplasmosis and MAC and almost bought the farm.

At my first visit to the ID clinic my labs as of 4-08 were CD4 of 6 and a VRL of 15,315. Since 3-10 my CD4 has been >200 although my CD4% has been 8, 9 or 10 and my VRL has been undetectable. I take ATRIPLA, DAPSONE, ITRACONAZOLE, GABAPENTIN AND LOPERAMIDE.

Via www.va.gov I can now review my medical records and labs on-line which is really, really cool Doctor!

My last labs (specimen collected 5-2-2011) HIV-1 RNA <48 HIV PCR Viral Load by COBAS Ampliprep/Tagman HIV-1 Test Version 1, nuclic acid amplification test for the quantification of HIV using real-time polymearse chain reaction (PCR). Is this, I am curious, the most sensitive test available? (<1.68 LOG)

Now under Flow Cytometry I know and understand what CD4 and CD4% means but you could touch on the others and is it important to know or ????

Mine as follows: CD3 = 1508 CD3% = 78 CD4 = 221 CD4% = 11 (HIGHEST IT HAS BEEN SINCE MY DIAGNOSIS yayyyyy) CD45 - 1922 CD45% = 100 CD8 = 1207 (which is marked high) (range 180-950) CD8% = 63 (also marked HIGH) (range 11-37)

And under Hemogram 1:

Could you touch upon what Erythrocytes are? I googled it and have an idea but what does it mean for those of us seropositive if anything.

Mine as follows:

Erthrocyte Distribution Width 12.7 % " Mean Corpuscular Hemoglobin 32.9 pg which is marked high (??????) and 4.07 M/cmm which is marked low and I won't bore you with them all but all are normal except for HEMOGLOBIN 13.4 marked LOW (Range 13.7-17.5) which would indicate slight anemia doesn't it? I know I have been borderline anemic since my discharge from the hospital and I think is the reason that I get a little fatigued from time to time. Am I right? Or is it from working my ass off or both? BTW Leukocytes and Lymphocytes in normal range but showing monocytes showing low 0.26 K/cmm but % normal. So with my CD4 being low would it follow that my white blood cells would be low as well? Could you clarify briefly?

Thanks again for all you do Doctor. Love reading your answers to other questons and love the wit! You are the best!

Response from Dr. Frascino

Hi.

Your HIV PCR RNA viral load measures down to 48 viral copies per ml. That's extremely sensitive. There are some ultrasensitive assays that measure down to 25 copies, and some research assays that get down even lower than that. But to answer your specific question, yes, your test is extremely sensitive.

A thorough explanation of all these tests would be extremely technical, complex and boring. It's also beyond the scope of this forum. Basically T-cells come in several flavors. CD4 cells are called helper T-cells, and CD8 cells are termed suppressor T-cells. They help the immune system balance its response to invaders in a yin and yang sort of way and provide different immune functions. Activated CD4 cells are susceptible to HIV infection. For CD4% versus CD4 absolute count, see link below.

Erythrocytes are red blood cells. For HIVers anemia can be a problem (low red blood cells and/or hemoglobin). You can read all about that topic in The Body's expert forum devoted to fatigue and anemia.

Your hemoglobin of 13.4 is only slightly low. I doubt you can feel this degree of anemia. Most folks don't. You have multiple potential reasons to have anemia. These include MAC, disseminated Histoplasmosis and even AIDS itself. Certain medications can also contribute to this problem.

Regarding white blood cell count (WBC), you can have a normal WBC and still have a low CD4 count or CD4%. The CD4 cells are only a small part of the entire WBC pool.

Finally, glad you liked the DVD!

Be well. Stay well.

Dr. Bob

Difference between CD4 and Percentage (CD4 count versus CD4%, 2011) (LACK OF CD4 RESPONSE DESPITE TREATMENT, 2011) Jul 22, 2011


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