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CD4 count after acute infection
Apr 30, 2006

Dear Dr.Mark: I am 37 years old. Being drunk I had unprotected oral sex with an unknown guy on January 23rd year 2006. 3 weeks later I started with fever, poliadenopathy, low leucocites and platelets counts, bleeding gums , weakness, diarhea, poor appetite, night sweats, , poliarthralgias and muscle pains, oral and genital ulcers, so I suspected it could be an acute HIV infection and ordered myself and ELISA and P24. Unfortunately I was right. Elisa test was negative and P24 positive. Some sympthoms lasted for more than 3 weeks. On March 7th, 6 weeks after infection I had my CD4 and VL performed(CD4 368 - 13,8% and VL 260.000). I saw an specialist that suggested another test in a couple of weeks. I was thinkimg of doing so 8 weeks after last tests. I still feel a little tired, have a persistent nasal congestion and foliculitis in many parts of my body. CD4 are supposed to raise and VL go down some weeks after an acute infection...but I am afraid of my clinical situation is more complex considering I reached a CD4% of less than 14%. Although my CD4 absolute count. What do you think about my CD4, viral load and possibilities of treatment in this case? Should I wait for other tests results? According to CD4 % (less than 14%) could we say that I had AIDS during acute infection? What about prognosis in my case without starting treatment right away?

I am very worried about preservation of my immune system. I need other opinion to decide treatment now.

I expect your prompt reply. Thanks a lot for your help and congratulations for your work.

Response from Dr. Holodniy

We can see this kind of decline in CD4 count during acute infection. Your CD4 count is likely to go back up once things stabilize in your body. I agree with close followup to see where the trend is going. If on the next couple of followup labs your CD4 count and percent is stuck at the current level then HIV treatment would be an option. If on the other hand you numbers are back up, I would hold off on treatment.



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