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Decreased CD4, KS Lesions, Chemotherapy

Jun 3, 2012

Hullo Dr Holodniy,

Thanks first of all for offering your expertise in supporting and responding to this forum. We are forever grateful and express our sincere gratitude.

This is our dilemma; we are hoping that we could get some direction on how to move forward.

38 yr old female diagnosed with HIV 2 years ago. CD4 was about 150. Treatment was started with Atripla. 6 months ago VL was undetectable and CD4 about 380. Approximately 6 months ago noticed lesion on leg. Most recently diagnosis by epithelial biopsy - KS macro stage. CD4 at this time from two separate reports 190 and 280 undetectable VL. 1. Is it possible to have different numbers (CD4 counts) with a difference of about 100 units in a space of a week? 2. Could this mean there is resistance to the current regimen Atripla? Is it suggestable to change the regimen (Atripla) at this time based on the numbers (possible case of resistance considering declining CD4)? 4. In regards to the KS (single lesion on leg first noticed 6 months ago) Abd CT and Chest X-ray negative for lesions, no bloody stools or shortness of breath. The Dr. recommends IV Vincristin to treat the single lesion. Considering the low CD4 versus the risk of the KS spreading (even though localized at the moment) versus the possible side effects of IV chemotherapy is IV chemotherapy recommended? Wouldnt this be too aggressive (IV Vincristin) versus surgery to remove the affected tissue or radiation therapy (more conservative approach)? The argument is that the IV would take care of the un noticeable lesions if any. What are your thoughts on this? Your response is highly appreciated.

Response from Dr. Holodniy

1. Seems unlikely to be a real change. 2. Very unlikely given the undetectable viral load. 3. I wouldn't change the ARV regimen. 4. Given the local nature of the lesion, I would favor local treatment at this point.

Almost non-detectable viral load
Viral load and CD4 cell count discordance

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