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Drop in CD4% - result of a hard workout?
Jul 29, 2012

Hi Doc -

Thanks for answering my question. I want to give you my numbers right off the bat and give you my background. I was first diagnosed poz on 2/14/11 and immediately went on Atripla. At that time my CD4 was 129 and 12%, VL of almost 100,000. On 5/11/11 I had 204 and 14% and VL under 400. 8/10/11 234. 16% and undetectable <48. 11/14/11 251 17% VL <48.

On 3/7/12 I was extremely excited as my VL <20 CD4 up to 340 and 20%. However my last two visits have shown a slowing of progress and even a regression. 5/23/12 VL <20 295 20%. This morning as I write to you I am able to see my most recent values through an online lab service, except it doesn't show my Viral Load. So 7/23/12 VL ?? CD4 256 18%. I have never missed a dose of a Atripla - in fact there were two occasions where I mistakingly took two doses

I am 39 years old, white male.. I am a track coach and stay pretty fit by running about 5 days a week - lift occasionally (I should do more but). I take a lot of vitamins including Kpax.

So here are my questions - is it possible that despite my high adherence that the virus is becoming resistant? The other possibility is that this one blood test was just an off day for my immune system - not sure if that is possible or not - but earlier in the day I went on a particularly exhausting run. In fact I had told my wife that it has been a long time since I had "bonked" like that on a long run. I rarely walk on a run but I found myself 3.5 miles away and exhausted on my run in 95 degree heat day. For the first time in a long time I had to walk a little and run a little on the way back in. Later that day I had my appointment. Could this type of exhaustive workout show up on my lab values? On that same day my Lipid panel results also jumped up a little as well as my Creatinine (normally around 1.12 but on 7/23/12 it jumped to 1.79). I also noticed my neutrophil # jumped up from normally between 2.5 and 3.4 K/uL to 7.3 K/uL. I had just read that Creatinine and Neutrophils sometimes jump up after a particularly exhausting workout. So is it possible that all of these lab values are just off because of my workout on that day? Should I ask my doctor to just test again to see if it was? If not what should my next step be? Should I get another resistance test? Help, this is the first time I have felt like I have regressed ...

Response from Dr. Holodniy

First, given your undetectable viral load the likelihood of developing resistance to your HIV meds is extremely small. We don't have good studies to measure the effects of strenuous exercise on CD4 counts. I general, I would not be concerned about your numbers and just have them repeated when you have your next visit.



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