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VR undetectable but CD4 still low
Jul 13, 2008

Hi Dr. Holodniy My Wife has been HIV positive for almost 15 years. She started taking meds about 2 years ago when she had diarrhea for a week and her CD4 count dropped to 52. Since then her CD4 count increased to 111 but has hovered between this and 128 since she has been taking medication. Her viral load is still undetectable but I am concerned about her CD4 count not increasing. She is taking Co-Trimoxazole (2 a day). Many people that I know that have started meds have CD4 counts above 200 and one of her friends CD4 went from only 2 to over 600 in a few years. I am wondering if there is cause for concern and if there is anything we can do to increase her CD4 count. Her doctor says that it takes a while for this to improve but I would be extremely grateful for a second opinion. Here is a list of her latest blood work along with the medication she is taking. T cell subpopulation count WBC: 3200 cell/mm3 % Lymphocyte: 38.2% T lymphocyte: 69% T lymphocyte, ABS count: 841cell/mm3 T helper (CD4); 9% T helper, ABS. count: 116 cell/mm3

Viral load: undetectable

Routine chemistry Sugar: 90 mg/dL BUN: 10mg/dL Uric Acid: 4.5mg/dL Cholesterol: 176mg/dL Trigly: 111mg/dL D-BILI: 0mg/dL T-BILI: 0.4mg/dL SGOT (AST): 28U/L SGPT (ALT): 28U/L ALP: 56U/L HDL Cholesterol: 54mg/dL LDL Cholesterol: 100mg/dL

Stat chemistry Crea:0.73mg/dL TP: 8.4g/dL AB: 4.3g/dL Globu: 4.1g/DL

Medication GPO VIR 530 (d4T, 3TC, NVP)- 2 tablets, 2 times a day Co-Trimoxazole (Bactrim)- 2 tablets, once a day

Response from Dr. Holodniy

All in all, the labs look pretty good. The total WBC and total lymphocyte count are low, so that may be affecting the absolute CD4 count to some degree, although the CD4% at 9% is about where you would expect it for a CD4 count of 116. Assuming she is not taking any other meds that could be affecting the blood counts, it could be the co-trimoxazole and d4T that might be contributing to low counts. She shouldn't stop the co-trimoxazole, but if there is any possibility of using other HIV meds that don't contain d4T that might help. Also, it may take longer to see an increase the lower the starting CD4 count is when you start. The first important part was to get the viral load undetectable. We have seen the CD4 count continue to increase over several years. So I wouldn't give up on seeing any further increase.



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