Nov 25, 2006
In your experience, or professional opinion, if a patient has never been <200 but goes there after beginning peg/riba, assuming the counts do rebound after completion of the regimen, how long might that typically take? i.e. "if you're not back >200 within 6 months of your last peg dose, you're not going to make it without HIV meds". Mine have gone from 119 to 152 after my last peg, but of course I'm not necessarily expecting another 33 point jump next time. (My % have always been >19; no VL since '98).
Response from Dr. McGovern
You bring up the excellent point that CD4 counts can decline after peg interferon therapy for hepatitis C. That is why I don't follow the CD4 counts closely - but I do follow percentages of CD4 cells - which usually stay the same or rise by about 3 points.
Your particular situation is interesting also in that you have a respectable CD4 percentage and no detectable viral load since 1998; yet you have a low CD4 count. I suspect that you always have a low total white count; therefore your total CD4 count always appears lower than it may seem by your excellent general health.
I would also wonder if you have any evidence of advanced liver disease by biopsy. Sometimes this can cause lower CD4 counts in my opinion. Thsi is probably due to enlargement of the spleen that can occur due to "portal hypertension" - a back pressure from the liver.
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