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Viral Load and OI's
Jan 4, 2002

Doctor,

My partner and I will be going to get his second round of viral testing and CD4 count, he was recently discovered + (I am neg). His first revealed 700 CD4 and 30K VL. However, we obvious don't want to deal with drugs until we have to, if his VL goes to 100K but his CD4 stays above 500 should we begin medication? If we don't would he be more susceptible to an OI with such a high VL even with a high CD4 count? And last, is it possible to have a VL above 100K with a CD4 of 500+, what would you recommend in this situation? Thanks a million!

Response from Dr. Feinberg

Although it is logical to assume that high viral loads and low T cells go together, and that low viral loads and high T cells also go together, in reality people with HIV can have any combination of T cells and viral load. Current thinking suggests that with CD4 cells above 500, or even above 350, it is OK to wait to start HIV treatment. The decision to be treated always has to be individualized, so in the end it will be up to your partner and his doctor to make a go/no go decision at a given time. Susceptibility to OIs is driven by the CD4 cell count, not by the viral load, although persons with high viral loads may experience a more swift deterioration in their CD4 cells.


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