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Understanding Labs and HPV vaccine
May 10, 2009

Dear Dr. Holodniy,

I was diagnosed HIV positive January 21, 2009. I did not suffer from any acute stage symptoms and I could have been infected for up to three years. My first labs: VL 17,800 CD4 675 (25%) My second most recent labs: Lymphocytes: 3,400 / Total T Cells(CD3) 2,040 (60%) / T Helper(CD4) 782 (23%) / T Suppressor(CD8) 1,190 (35%) / T4-TB Ratio 0.66.

I am worried about the decline in CD4 percentage (I understand it should be around 40%). I am also worried about the ratio (which I understand should be between 1.0 and 2.7). I live in Israel, and we have very good medication available. I think I'd like to begin treatment asap. My doctor is also a proponent of early treatment. If I can begin at this stage, do I have anything to lose?

My second question is about HPV vaccine. They don't do anal pap screening here. The vaccine is available, though, mostly for women. My doctor has recommended it. Should I? Could it be dangerous for me in any way to get it?

Thank you very much.

Response from Dr. Holodniy

A 2% difference would not be considered significant, although as you point out, your percent is already decreased despite a normal absolute CD4 count. There is no urgency to start and you have to weigh the long term benefits of treatment with the potential for long term side effects or toxicities of HIV medications. There is no danger is receiving the HPV vaccine. It is more a question of does it work for this indication, particularly if you may have been exposed to HPV strains already that are associated with development of malignancies.



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