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VL up and CD4 down -- what to do?
Jun 18, 2000

03/99 tested positive: VL 49,000 and CD4 183 (15%). Mostly asymptomatic, except for molluscum contagiosum and zoster once. 04/99 began HAART: 3tc, abacavir, efavirenz 03/00 increasingly good results: VL <13 and CD4 427 (25%) 06/00 things have gotten a little worse: VL 125 and CD4 350 (26%) My doctor feels we should wait another 8 weeks, test again, if VL is in the thousands get a genotype test to see what med is failing, and the only new possible addition/substitution is a PI. 1) I'm still asymptomatic but do worry a bit about the change. What is your take on a situation like this? 2) I'd rather avoid PIs as long as possible. Do you think there is an alternative? Thanks!

Response from Dr. Holodniy

You are suffering from a "blip". We are not sure as to the clinical significance yet of these. It may just be assay variability, or it could reflect true breakthru. Although your absolute CD4 count has gone down, your percentage is stable. If we were to look at your total white blood cell count and total lymphocyte count from both time points, I suspect the first time point has higher values, which is why with the same percentage of CD4 count, the absolute values are different. I would wait and repeat as well and look at another set of numbers to see the trend.

MH



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