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I m being frustrsted and no doctor in my country has an answer

Aug 26, 2018

Hello Doctor, I am living in a country where doctors are not real experts in HIV; this is why I decided to contact you in order to try to find answers to my concerns....

I was diagnosed with HIV1 acute infection in May 2017 with a viral load of more than 10 millions. I started taking Genvoya since then. Actually, 15 months after starting the treatment, My viral load is 52 copies knowing that 8 months ago I reached a VL <40 copies and started to fluctuate over 50 copies after that. The only medication i m taking with genvoya is Nexium 40mg (10 hours after Genvoya)

In July 2017 (2 months after treatment initiation) VL= 802 Neutrophilis (%=63 ; A.V= 3.53) Lymphocytes (%= 28; A.V= 1.57) CD4=330 CD4%21. Cd8=627. Cd4/cd8= 0.53

In August 2017 (3 months after treatment initiation): VL = 71 copies Neutrophilis (%=47 ; A.V= 1.93) Lymphocytes (%= 44; A.V= 1.8) Cd4= 289. Cd4%16. Cd8=649 . Cd4/cd8= 0.45

In November 2017: VL<40. cd4= 370. Cd4%22. Cd8= 907. Cd4/cd8= 0.41

In January 2018 (8 months after treatment initiation): VL= 67copies Neutrophilis (%=46 ; A.V= 2.76) Lymphocytes (%= 48; A.V= 2.88) Cd4= 338. Cd4%12.3. Cd8=1907. Cd4/cd8= 0.18

In April 2018 (11 months after treatment initiation) VL=52 copies Neutrophilis (%=39; A.V= 1.91) Lymphocytes (%= 53; A.V= 2.60) Cd4=507. Cd4%19.5. Cd8=1663. Cd4/cd8= 0.31

In August 2018 (15 months after treatment initiation) VL=81 copies Neutrophilis (%=40; A.V= 2.28) Lymphocytes (%= 52; A.V= 2.96) Cd4=584. Cd4%19.7. Cd8=1941. Cd4/cd8= 0.30

Dear Dr. I have three real concerns :

1- does this low viremia affect my health more negatively than if I had an undetectable VL?

2- Since this low but detectable viral load is stressful for me, does any additional ARV or any switch to another ARV help in reaching undetectable VL? Knowing that I have done the genotype resistance test before starting treatment. The result showed no resistance.

3- I am so concerned because of my cd8 increase . Is it in anyway related to the change in percentages of neutrophils and lymphocytes? And what are the additional medical exams that can interpret the increase in my cd8? Knowing that I did all the tests of syphilis, hepatitis and the results came negative. The HBV positive but inactive. The ESR test result is normal. The LDH test result is normal. I am really afraid because of the increase of cd8 and the chronic change of neutrophils/lymphocytes percentages. Is it because of a hidden cancer?

N.B: I had an eye stye in February 2018 that is still going and appearing again from time to time.

Waiting for your reply impatiently. Thank you in advance

Response from Dr. Holodniy

Your numbers are great and I would not be concerned. I don't think you need to add another ARV at this time. Your CD8 count increase is in reaction to HIV infection and is a very common finding.



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