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Recently seroconverted, questions about rapid CD4 decline

Jan 25, 2003

Hi, I really hope you're able to provide some insight into my current situation - as it has me fairly worried at this point in time.

I seroconverted sometime between June and July of 2002. I had a negative test in May, 2002 and a positive test in August (ELISA & Western Blot). My lab results have been as follows: Sep: 740 CD4 and 9,000 VL, Nov: 670 CD4 and 21,000 VL, Jan: 580 CD4 and 44,000 VL.

I have always been extremely healthy, rarely got colds, sick or the flu growing up.

Most of the literature that I have read says that an average treatment-naive patient will usually have CD4 declines of 50 to 100 per year. At this rate, mine seem to be declining about 800 per year!

I had no signs of seroconversion illness, and felt fine through the summer, with the exception of 2 weeks of mild diahrea.

My doctor belives that I have already gone through the seroconversion "spike" in CD4/VL and that this is just the gradual worsening of my situation.

Everyone talks about reaching a "set point", and about the spike in VL and decline in CD4 that most experience duing seroconversion. I haven't really seen evidence of either of these situations in my case.

The doctor also ran a genotype on my virus, and found these mutations: 36I, 41L, 210W, 211Q.

Do you have any possible theories as to why my levels are declining so quickly?

Response from Dr. Holodniy

Sounds like you might have acquired a fairly aggressive strain and it has some evidence of HIV drug resistance as well. The 41L and 210W indicate AZT resistance. if the testing lab where your labs were performed has any plasma left from your first viral load tests, it would provide useful information if a resistance test were to be run on that sample. You may need to start treatment sooner rather than later, and the resistance test information will be critical in designing a regimen for you.

CD4 stay low
Depression, Viral Load, CD4

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