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Do I need prophylaxis?
Mar 14, 2002

Recently, I had a viral "blip"and my CD-4 percent dropped to 13. My VL became detectable at 375. My absolute CD-4 count remains at 465, although that is a drop from 515. I hear varying reports on CD-4 percentage. At 13, should I be on prophylaxis for PCP? Isn't 13 the equivalent of an AIDS dx, despite CD-4 count? How immunocompromised am I at 13? And should I be pushing my physician for more aggressive ways to bring up my CD-4 percentage?

Response from Dr. Feinberg

If your absolute CD4 cell count is well above 200, ours is, then don't worry about the difference between 13 and 14%. The standard of using 14% was set some years ago when it was thought that 14% was closely correlated to an absolute count of about 200. That does not turn out to be the case; it is the absolute count that should be the trigger for whether prophylaxis for PCP is needed or not.

There is tremendous variation in people's CD4 cell count repsonse to HIV treatment-- some people get whopping increases-- even totally normal numbers-- and others have minimal changes. In your case I think the issue is to focus on getting your viral load to below the detectable limit, and your CD4 cells should follow suit. Good luck!


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