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Estimated recovery time for CD4 less than 200 ?
Jun 11, 2006

Dear Doc,

I guess my specialist care provider and I did not understand one another clearly enough when my CD4 count fell below 300 late last year. We had decided to start a "Doctor sanctioned HAART holiday" in June 2003, after I was V/L undetectable for at least three years, along with VERY HIGH CD4 counts. Some 30 months later in December 2005 I resumed Combivir and Sustiva therapies when my CD4 count was hovering just above 200. Unfortunately, a few weeks later a follow-up test showed my CD4 to be below 150. It has since varied to a high of 203, and it fell last month to 160. The good news? With the resumption of therapy, my viral load immediately dropped to "undetectable", with one flare-up in the mid-200's for one month's test results. My doctor specialist and his physician's assistant in January this year could not hide their disappointment with the below 200 T-cell numbers, but are greatly encouraged with several tests (early 2006) with the V/L undetectable. Bactrim has been added to my "regime" (three days per week, looks like 160 mg per) as a preventative to PCP infection. I guess that we jointly blew the chance to resume therapy when things were around 300, because he thought I wanted to continue NOT taking HAART, and I viewed the situation as "he is the expert, I will wait until he says to resume...". Incidentally, it was my Doctor's suggestion to go on the "HAART holiday" in 2003, not mine. Otherwise, my provider is a big believer in "empowerment" and participation of the patient in care decisions. (I wasn't raised that way...). Anyways, my Doc won't say much about my prospects regarding any come-back CD4 cell wise, over time, to my prior relatively high T-cell count (it had reached 1,200 just prior to the "holiday", when V/L was undetectable after four years of therapy). My question is this: Any data out there that may have studied the recovery of CD4 counts? I'm responding to therapy, thank goodness, but my T-cells count has been decimated and I would like to see it grow to a safer number. Many thanks, you've answered questions for me before. Regards,....

Response from Dr. Holodniy

I think it unlikely you will get back to 1200. Recovery after interruption that has resulted in the decline you have experienced will be slow and incomplete. My guestimate is you will end up somewhere in the 200-400 range over time.



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