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Acute HIV - Immune Response

Jan 30, 2011

I was infected on 10/30/2010. I became ill with flu like symptoms on 11/19 and was sick with a fever for exactly 2 weeks (never went above 101). I feel fine now, except for anxiety. Tested positive on 12/2. Blood test results: 12/3 VL 1.8 mil CD4 572 5%, 12/13 VL 800K, CD4 470 8.5%, 1/27 VL 660K CD4 369 14.5%. Genotype came back not resistant to any regimen. I have not started therapy yet and am debating on when to start. Is it typical for VL to stay this high 3 months after initial infection? Also, do you think the CD4 will rebound? I am debating on when to start meds and am worried that CD4 could drop below 300. Is it possible to drop this low this early in infection, or is this typical?

Response from Dr. Holodniy

Yes, the CD4 count and/or percent can drop dramatically with acute infection, and then recover in the next few months as the immune system gets control of the infection. Likewise, the viral load can remain elevated for some period of months and gradually decrease to a set-point level once the immune system and the virus are in equilibrium. You have had a 3-fold decrease in viral load in 3 months. It could drop some more and is hard to predict. I think you need another point or two on the line before making a treatment decision. If the viral load continues to go down and the CD4 percent continues to go up, you could hold off. If you see these numbers starting to level out, then I think starting treatment sooner would be the right move.

Severe conjunctivitis
Drastic drop of CD4 count

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