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Scared to Death in Africa and Need to Know
May 12, 2001

I am an American woman, married to a Zimbabwean and living in Africa. My husband and I have been together for the past five years and although I have had suspisions in the past, have recently confirmed the extent of his sexual compulsivity. At any rate, although I have tested neagtaive, in February he tested HIV positive with the following results. Levcocyte Count 5.30 Lymphocytes 24.1 Total T cell CD3 817/cmm Total T cells CD3 64 CD4 cell count Helper 370/cmm CD4 29 RNA Copies 61900 Log Units 4.792

The first physician that we consulted prescribed a very expensive and complicated dosing proceedure which had a high liklihood of negative side effects. Subsequently before beginning any antiviral treatment, we choose to meet with another physician for a second opinion.

On March 29th, my husband was retested with the following results. CD4 count helper 480 RNA Copies 122,000 Log Units 5.086

On April 15th, my husband began antiviral therapy which is comprised of Combivir and Viramune.

Give the limited information provided, I would like to ask the following questions.

When may my husband have become infected? How is it that I am negative? Why has since CD4 count increased prior to the initiation of antiviral therapy, whereas his viral load has nearly doubled? What are your thoughts with regard to the treatment prescribed? To what extent has his immune system been damaged? What can we hope for in terms of life expectancy with and without antiviral therapy.

Thank you in advance for your assistance.

Scared to Death in Africa!

Response from Dr. Holodniy

#1. Impossible to answer, unless you have evidence of past negative tests. #2. Could be timing of his infection and your last unprotected encounter with him. Or it could be you are lucky and have a very good immune system. #3. You don't indicate the percent CD4 on the last set of values. We can see fluctuations in the CD4 count related to time of day, other intercurrent infections, or different labs. The CD4 percentage is usually a more stable number over time. The viral load, although appearing to be a great change, is only a 2 fold difference and within assay variability. #4. Good, effective, easy regimen to take. #5. His immune system is in very good shape. #6. Without antiviral therapy, almost certain death. With treatment, and good adherence to the regimen, many people could live a normal life span. MH



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