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PML and CD4 Count

May 29, 2000

Dear Dr. Holodniy,

I have written to you before about my brother that was diagnosed in Nov of last year with PML. Since my last question, my brothers CD4 count has risen to 124 and viral load still undetectable -- last blood work May 11, 2000. I was told by one doctor not to be so concerned about the CD4 count now as long as the viral load stays undetectable and another doctor told me that when someone starts out with such a low CD4 count (10) that it usually only goes up 100 points and if they are really lucky it will raise by 200. Is this true? My brothers count only came up by 4 since February and he seems to be at a stand still -- sometimes I think his speech is not as good as it was a month ago and his walking is not as good. Of course he has not been keeping up on his therapy like he should and I am not sure how far I can push him or if his condition is starting to deteriorate again or if he is just in a slump. If his CD4 count does not go any higher does this mean he will not improve any further than he has? I would appreciate it if you could answer these questions, I am so confused and not sure what to do. Thanking you in advance for all your help. Sincerely, Are

Response from Dr. Holodniy

Both doctors are saying things that are correct. It is rare, but possible, that his CD4 count will go above 200. However, that number is sufficient to reduce the risk of developing most HIV-associated infections. 124 is much, much better than 10. As long as the viral load is <50, viral replication will be shut off and CD4 counts should stay relatively stable. He needs to keep up with his meds. Partial adherence to his meds will result in the development of resistance, and failure of his regimen. He either needs to take all his doses, or not take them at all.


Reasons for high VL and low CD4 so soon
Free Viral RNA in bloodstream

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