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3 sets of labs in 6 weeks

Sep 28, 2003

Dr. Holodniy, I have had three sets of labs over the pas 6 weeks, each within 2 weeks of the previous one Results

1st CD4 1237 52 VL 56,000 Lymphocytes 2333 2nd CD4 347 16 VL 27,000 Lymphocytes 2167 3rd CD4 332 16 VL 16,000 Lymphocytes 2074

How is it possible to drop so much within only 2 weeks from the first to the second test? The Dr. said he's never seen that before and he's been studying HIV and treatment since the first cases in the early 80's. I had a cold prior to the first set of tests and I have a cold now. I may have had a possible exposure 2 weeks prior to testing positive in July, though my Dr. feels as though this is probably not when I was infected as my VL is not high enough. He feels this is older than 5 years due to my low CD4 count over the last to test results. He wants me to start meds and took blood yesterday for genotype testing and what he called a virtual phenotype test. Should I get a second opinion? Should I start meds? He said with my last two tests, I'm on the border line. I guess I'm scared to start meds, because after I start, I probably won't ever be able to stop. I also feel as though once I start, this is it. I've entered that area where I won't have as much hope. Resistance can build and force me through all of the available drugs within just 6 years. Then I have no other options. What are your thoughts?

Thank you,


Response from Dr. Holodniy

I think the first CD4 count and percentage were wrong. Everything else is very consistent over time. Your doctor is correct, you are on the bubble in terms of starting treatment. Current recommendations are to start treatment when the CD4 count is < 350 and/or the viral load is > 50,000. Given your numbers, you could afford to wait a little while. In other words, check your numbers in 3 and 6 months. If the CD4 trend is down, you start. If stable, you could wait another 3 months, etc. Alternatively you could start now, get your viral load undetectable, and enjoy a CD4 count > 500. That is what I call great hope....

CD4 up, CD8 up, ratio lower
How am I doing? I am not so hopeful, followup.

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