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CD4 Count - Dramatic drop, indifferent doctors
Oct 24, 2004

Hi,

My partner (Billie) was diagnosed HIV+ in August 2001. I am HIV-(last tested May, 2004) Billie's CD4 was approx 650 at the time, recent tests have been 04.2003 approx 550, 01.2004 approx 770, 09.2004 approx 175.

This is a dramatic drop that I can't begin to explain or understand as Billie eats well, exercises regularly and aside form the very occasional common cough or cold (in season) outwardly appears healthy.

She has this week started to develop shingles - the second time in four years and she has spoken to her (Thai) doctor about her recent results who seems very indifferent.

I know that she must start medication immediately and we plan to see her doctor - who is not an expert on HIV infection (but will ask a friend?)on 27.09.

Billie is Thai and we live in S'Pore.

Without exception, every time we have spoken to a doctor in Thailand (even the HIV experts), they have been unsympathetic, fairly unknowledgable and of little help quite frankly.

They have more concern over Billie's ability to pay than offering advice and support -

Can someone please advise me what type of drug regime that they should be recommending for Billie as a first line?

Can someone please advise me what I can expect to see in then next few months regarding Billie's overall health and responsiveness to treatment?

Can someone please advise me of the frequency of testing that Billie should be having moving forward to ensure that her viral loads are under control and that she is repsonding to medication?

I speak Thai (but not to the level required to have complex medical discussions)and most Thai doctors have quite poor English - so our problem is exacerbated by language barriers.

Treatment in Singpaore, regrettably, is not an option.

Please help - I need a check and ballance in order to help me deal with the doctors in Thailand next week

Thank you in advance -

Response from Dr. Holodniy

That is quite a significant drop in CD4 count over one year. It does not appear that viral load testing is available to determine whether the viral load is very high and indicates why there has been such a significant decline. If the CD4 count is repeated and again below 200, then treatment should be started. Treatment is usually with 3 drugs from two different classes of medications. It is difficult to recommend the exact regimen, as every patient is different, and multiple factors come into play including other ongoing medical problems (which may also be requiring medications resulting in drug interactions), patient preference and acceptibility of various side effects and complexity of the regimen.



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