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CD4 counts and a concerning scenario

Sep 22, 2013

Privyet, Dr. Holodniy!

I just had a few questions about CD4 counts:

Why is it that, besides taking medications, we can't really do anything to naturally raise CD4 counts?

Also, you mentioned (in the question: "CD4 count to no longer be drawn with quarterly labs") that some developing countries don't even bother to look at viral loads but rather focus only on CD4 counts - yikes! What would be the benefits of only reporting the CD4 counts instead of reporting both CD4 counts and viral load levels? Wouldn't that be a bit concerning for the patients who, although maintaining a healthy CD4 count, unknowingly experience a consistent increase in viral load levels?

In a very concerning scenario - although I'm not sure if this is even possible - what if a patient experiences resistance to meds and, while having only slight variations in CD4 counts that might be mistaken as blips, has silent, consistently increasing viral load levels?

What is your take on only focusing on CD4 counts and not paying attention to viral load levels?

Thanks for your help!

Response from Dr. Holodniy

Many things have been tried and studied, and although some things have been found to acutely increase the CD4 count, either the quality of the cells (function) or long term impact (death rates, AIDS diagnoses, etc) has not been improved compared to nothing or placebo, even while HIV treatment was being given. This continues to be studied.

You are correct in your observation about only looking at CD4 count without viral load. Things could be happening underneath the hood and you might not know about it until its too late. Much of the research work in this area is being done in developing countries, where the resources are limited and they are trying to determine what is the most cost-efficient way to monitor patients (i.e., less frequent testing or less test types).

when do i start getting worried about non-response ? or should I just be patient?
Persistently detectable viral load

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