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Viral Load undetectable but CD4 cells going down

Feb 23, 2001

Dear Dr. Holodniy:

When I was diagnosed 3 years ago I had a viral load or 150,000 and CD4 cells at 498. One month after treatment viral load went undetectable and CD4 cells went up to 898.

Ever since then it has remained undetectable but CD4 keeps coming down steadily. First it went below 500 and now CD4 count is at 289. Also percentage has gone down from 38 to 32. Except cholesterol, which is at 248, everything else seems normal. What troubles me is my doctor says my case is unusual since CD4 keeps dropping but I remain undetectable <50.

I was taking Combivir/ Ziagen/Agenerase/Norvir. My doctor said taking away the AZT portion would probably solve my problem,since AZT could be affecting the other medicines so he substituted Combivir for Epivir.

I am extremely concerned that next time I check myself my CD4 count will be at or below 200 (AIDS). Any suggestions? I am desperate for another opinion. Please reply as soon as possible.

Response from Dr. Holodniy

First is your WBC count or total lymphocyte count normal? The AZT could be affecting your blood counts, and hence your CD4 count, particularly if you are on other medications that might affect your bone marrow's ability to produce cells. I have seen some cases like this without an explanation. Sometimes switching HIV meds helps. Sometimes adding some interleukin 2 (IL-2) to increase CD4 counts helps. MH

Low risk, positve PCR

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