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Confused About Numbers
Jun 27, 2010

Dear Doc,

I just had my regular appt today. Diagnosed 17 months ago, but pretty certain been poz for 9 years. Over these 17 months, my CD4 has been between 700-800 with a % bouncing back and forth between 26% and 23%. Before today's labs, my last 2 labs were CD4 811 at 21% with a viral load around 28,000, then CD4 703 at 23% with vl around 12,000. I realize that is basically no change.

Today, my numbers were CD4 668 at 20% with vl of 9,000. When I gave the blood for this lab, I had been having bad pains under my right rib. When I had it checked out, they said I was just constipated and my liver numbers were good. My doc says the constipation and the anxiety of wondering what the pain was could have caused the drop. Also, it seems whenever my vl drops, my CD4 takes a hit.

My doc says I'm doing great and suggested I could wait 4 months instead of 3 to come back. I'm a little concerned about that 20%. There seems to be a trend of my % dropping. Over the last several labs, it hasn't gone back up to the high 20's. When I was diagnosed, I got really sick and hospitalized. My % then was 19 and my CD4 got down to 171. That CD4 was obviously artificial. However, it does make me wonder whether things to start to happen once the % gets below 20% regardless of CD4. I don't know what my CD4 was before diagnosis. My doc says as long as my vl stays low I shouldn't worry myself.

I suppose I'll have to wait for a few more labs to see if there really is some trend going on. Do many docs suggest starting meds once the % drops below 20% regardless of CD4? If I'm correct about being poz for 9 years and still have these numbers with a vl of 9,000, it seems like my body is fighting the virus. Even with my doc telling me I'm doing great, that % worries me. He said if I start getting frequent colds and illnesses, then he would look more at that percentage.

Just wondering what your thoughts are on these numbers. I appreciate you taking the time to listen to all of us.

Response from Dr. Holodniy

I understand your concern, but also see where your doctor is coming from on this. Your CD4% is lagging from where it really should be with a CD4 count of 668. Your viral load is not that bad and so does speak to a longer time frame of infection where the CD4% may be starting to drop. I don't think there is anything to do urgently, but if on your next visit the CD4% is slipping below 20%, I might consider starting HIV treatment.



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