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HIV and Herpes
Aug 7, 2011

Hello -

I've been HIV+ for last 5 years and my CD4-VL count have been in a pretty good range so far. I'm not on meds yet. The CD4 count as of July 2011 was 830 and VL = 570, CD4% = 36%. I'm 37 years old.

2 weeks ago, I fell sick and I found out that I've contracted Genital Herpes (HSV-1) and I was also operated for Anal abscess. I've been reading horror stories about HIV acceleration due to Herpes and I'm concerned about my CD4-VL stability.

Will my numbers start crashing now faster than usual (Low CD4, High VL)?

My CD4 have fallen from 1400 to 800 in last 5 years, and VL has always fluctuated from undetectable to low hundreds. CD4% has fluctuated between 32-48. I also participate in slow-progressor study where I give blood every 6 months.

I also have Thelessemia Minor, but I do not take any Iron or other meds for it.

I'm on Valtrex at the moment and my doctor thinks that I may have to get on a permanent Suppresive therapy for Herpes.

Please also advise on any precautions that I should take to maintain CD4-VL stability. What are the chances of numbers crashing, if I stop taking Valtrex?

Thanks

Response from Dr. Holodniy

This herpes simplex infection could represent a new infection or reactivation of an infection acquired some time in the past. If it is the latter, this could further represent some loss of immune surveillance as evidenced by your CD4 decline over the last five years, even though your counts remain in the normal range. In general, for those people not on HIV meds, you will see an increase in HIV viral load and decrease in CD4 count that is usually transient during and shortly after a herpes outbreak. So I wouldn't be surprised to see a change in your numbers if you were to have them checked in the next month or so. Current thinking among experts is that these additional infections, particularly herpes viruses, can result in ongoing inflammation, HIV replication and further loss of CD4 cells. Thus, your doctor is likely correct about taking valtrex. Some experts would also say that this kind of situation warrants starting HIV meds as well to take the HIV replication out of the equation.



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