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Considering the recent new treatments, when's the best time to begin treatment?
Oct 22, 2005

I've been HIV+ since late 1998 (diagnosed in January 1999.) I have NEVER been on any meds. I have been getting blood work done regularly to keep an eye on my health (below is a chart of my test dates, viral load, CD4%, CD4 Abs, CD8% and CD8 Abs.)

My question is that my CD4 counts have hit 440, an all time low for me -- but my CD8% counts are higher? Is this normal? What are CD4 cells compared to CD8 cells? I know that a LOW viral load is good, a high CD4 count is good, but what do CD8 counts indicate?

My doctor (an HIV specialist) and I have discussed treatment once my CD4s get to 350, is this reasonable, or is it a risk? Knowing my history (below), what do YOU think? What are the benefits/risks?

Date VLoad CD4% CD4 Abs CD8% CD8 Abs --------- ----- ---- ------ ---- ------- 27-Jul-99 15133 33 595 48 3952 07-Sep-99 230 32* 711 50 1140* 21-Oct-99 586 31 828 53 1416 07-Dec-99 810 33 880 48 1280 07-Mar-00 8041 32 664 43 892 11-Jul-00 2917 30 758 52 1305 03-Oct-00 5719 28 729 50 1303 19-Mar-01 8144 27 1088 52 2096 15-Jun-01 19779 30 796 48 1274 16-Oct-01 30167 29 710 52 1273 15-Dec-01 25861 28 806 51 1493 16-Dec-02 45458 23* 715* 53* 1584* 22-May-03 11522 23* 715* 53* 1584* 15-Sep-03 98090 23* 715* 53* 1584* 10-Nov-03 11577 23* 715* 53* 1584* 06-Jan-04 14566 23* 715* 53* 1584* 18-May-04 23174 19 625 55 1584* 21-May-04 26636 22 617 58 1584* 27-Sep-04 37652 15 595 62 1584* 25-Jan-05 9867 14 518 67 1584* 11-Oct-05 33942 12 440 66 1584*

* Estimated, as full labs with CD4/CD8 counts were not provided

Thanks for any advice you can provide!

Response from Dr. Holodniy

An increase in CD8 count is a natural reaction to HIV infection. CD4 cells are the major cell infected and killed by HIV, and CD8 cells are the major cell that kills HIV. I don't like the trend in your CD4 count, particularly your CD4 percentage which has dropped significantly since 1999. Your CD4 percentage is significantly lower than your absolute CD4 count would suggest. A CD4 count of 14% or lower is getting into the AIDS diagnosis territory and puts one at risk for opportunistic infections. I might wait to see what the next results look like, but I would be inclined to treat much sooner than waiting for the absolute count to reach 350.



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