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Drop in CD4
Feb 23, 2014

My partner has been HIV+ since the early 1990s. He is now 60 years old. For the past ten years, he has been very healthy. Undetectable viral load and CD4 counts above 600. Last summer, his labs showed a CD4 count of 125. He has had 3 labs since then, each with undetectable viral loads and CD4 counts between 75 and 125.

He has been seen by his ID doc and a Hematologist. Results from a bone marrow scan were negative. He is awaiting results from a full body CT scan. He is also having an anoscopy to see if there are any anal lesions.

Meanwhile, for the last month, he is taking something other than bactrum to prevent opportunistic infections (I cant remember the name but it is a bright yellow, very thick liquid).

IN the lsat 3 weeks, he has developed severe diarrhea. Nothing seems to control it. His ID doc says he will test him for parasites, etc.

Something seems very wrong. He is scared, and miserable. The doctors seem as clueless as we are.

I have read your comments regarding people with chronically low CD4 counts (I am one of them). But what might account for a sudden and long lasting drop?

Response from Dr. Holodniy

We sometimes see this kind of CD4 collapse, despite undetectable viral loads. Sometimes the situation is explained by an alternative diagnosis (i.e., cancer) and sometimes we have no explanation. Given the repeated observation of these counts, it is likely real. You could check the CD4 count at another lab, but given the consistency it is likely to be the same. I assume the CD4 percent has also decreased significantly as well. I would also be interested to know what the total white blood cell (WBC) and lymphocyte count is, and whether they are normal or decreased as well, which could account for the low CD4 count. But given the apparent normal bone marrow biopsy, this seems unlikely. It sounds like all the correct workup is being performed and I would agree with the scans to rule out occult malignancy. The yellow liquid is Mepron, which is an alternative medication to prevent PCP, and is appropriate given the low CD4 count at this point.



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