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Concerned about cd4, still low.
Jun 16, 2013

Greetings from Peru Dr Mark I started ART in January 2013 with cv: 33000 and cd4: 97, my initial regimen was AZT/3TC/EFV and TMP / SMT as prophylaxis, in my control at 6 weeks my cv was undetectable and CD4 166, but I was with anemia due to AZT and it was switched with Tenofovir on that date. From February 20 I take TDF/3TC/EFV and still with TMP/SMT prophylaxis, but in my last exam in May I have hemoglobin 14, cd4 160 and cv undetectable, my concern is that the cd4 is not rising, otherwise is declined slightly. I never got sick or something. what could be causing this?, could be TMP/SMT?, and that could I do for help to increase my cd4? Very grateful

Response from Dr. Holodniy

I don't consider a difference between 166 and 160 to be significant. Another number to follow is the CD4%. Has it remained the same, or is it increasing? Although it is possible that TMP/SMT could be affecting your white blood cell (WBC) count, I would expect other WBC to also be affected. Given that your CD4 is still below 200, I would not discontinue the TMP/SMT yet, as you are still at risk for infections. Sometimes it takes longer for the CD4 to increase, and usually starts to happen after the viral load becomes undetectable. For now, I would do anything different.



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