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these #'s are making me crazy

Jul 19, 2004

I first converted in July 2004- went on treatment right away as part of a research study group. Combivir, Viread and another I cannot honestly remember...went off after 3 months cause I never went undetectable...lowest viral load was 7000. Doc said staying on and not going undetectable was doing me more harm than good. Took two resistance tests- came back as unresistant to any this point my T's were 900 and viral load went up to 50k...over the last few months since I have been off treatment (Nov), I go in every 6 weeks for a new viral load has stayed the same - around 50k, but my t's decrease almost 100 every test. I am now at 403. My doctors say that my percentage is almost the same- whatever that means- 23-21 % so I hae nothing to worry about....hpow can I not worry when the number keeps dropping every six weeks since November? Your comments would be greatly appreciated. My doctor talks to me like a robot reading a medical book and I am frustrated. Thank you.

Response from Dr. Holodniy

I understand your confusion and concern. It is somewhat difficult to interpret your numbers since we don't have good natural history data on you. What I mean by that is, in the absence of any treatment during acute infection, your immune system and virus production will achieve a kind of equilibrium called your setpoint. This is the CD4 count and viral load you are destined to be at for some period of time, which could be months to many years. When you are given treatment so early, it is difficult to know what those numbers might be, particularly if you stop the meds. It is curious that you did not get to undetectable, particularly with 4 drugs. There might have been an interaction between them causing them not to work as effectively as one would have hoped. It is helpful to know that you did not develop resistance to the meds you were on. The current recommendation is for starting treatment is when the CD4 count is < 350 and/or the viral load is > 50,000. Your percentage is relatively healthy, but could be improved with treatment again. The CD4 percentage is a much more stable number over time than absolute CD4 counts. I suspect you are reaching your setpoint, and if your CD4 count continues to decline, restarting treatment would be recommended.

High CD4 /very low VL actual Lab results
Southern Africa

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