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Unusual Lab Results
Oct 10, 2010

Hi doctor Mark,

I've written to you before about understanding my lab results and you've been really helpful. Thanks. My doctor has mentioned he thinks I may be a LTNP or Elite Controller as I am currently not on treatment and continue to hold my VL at bay. My results have been:

April 2007 (5 weeks post exposure) CD4 396 (18%), cd4/cd8 0.3, VL 299000

May 2007 CD4 487 (29%), CD4/CD8 0.7, VL 151000

June 2007 CD4 506 (33%), CD4/CD8 0.9, VL 64000

August 2007 CD4 404 (33%), CD4/CD8 1.2, VL 16700

November 2007 CD4 505 (29%), CD4/CD8 1.1, VL 6600

February 2008 CD4 535 (29%), CD4/CD8 1.1, VL 4500

May 2008 CD4 413 (28%), CD4/CD8 1.1, VL 5300

July 2008 CD4 417 (26%), CD4/CD8 0.9, VL 2100

Ocober 2008 CD4 554 (31%), CD4/CD8 1.1, VL 1300

February 2009 CD4 445 (31%), CD4/CD8 1.1, VL 1100

May 2009 CD4 507 (32%), CD4/CD8 1.2, VL 690

August 2009 CD4 426 (29%), CD4/CD8 1.1, VL 740

Janaury 2010 CD4 512 (36%), CD4/CD8 1.3, VL 690, CD16 354 (25.3%)

May 2010 CD4 505 (31%), CD4/CD8 1.2, VL 300, CD16 484 (30.1%)

Sep 2010 CD4 458 (23.5%), CD4/CD8 0.9, VL 260, CD16 783 (40.2%)

I have had a horrible RTI from late August - September lasting around 4 weeks and was untreated for that. I generally don't take antibitotics unless I absolutely have to. I had my latest Blood test on 21/9/10, which is when I still had this horrible chest infection. It still hasn't completely gone as I write this on 5/10/10.

My question is related to my latest results. Given the fact that my VL is low and has remained low is it usual to see such a drop in my CD4 % and such a spike in my CD16 count and % over the last couple of tests?

I'm starting to wonder if I may have a low VL but the virus is doing damage to my immune system anyway?

Can you give me your views? I'm hoping the unusual results from Sep10 will be due to my RTI and nothing more to it.

Cheers and best wishes, Worry wart.....

Response from Dr. Holodniy

That's a pretty big decline in CD4%, given your stable numbers over time, and could be accounted for by another ongoing infection. It is interesting though, in the absence of HIV treatment, you did not see an increase in HIV viral load concomitant with the CD4 decline. My prediction is that when you have recovered, your counts will come back up.



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