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viral load <50; t-cells fluctuating?

Mar 13, 2000

dear dr. holodniy,

i'm a 50 year old male, hiv+ since about 1980. i have never had an OI, and have on antiviral therapy for about 10 years. {azt initially, then indinavir, + 3tc, + azt, and now viramune and combivir}.

i never had a baseline viral study, so all my data shows viral load as "undetectable". the first viral load study was done several months AFTER initiating HAART, and was <400.

at the time i began the crixivan/azt/3tc therapy, my t-cells were around "0". after about five years of treatment, my viral load has been consistenly <50 [ultra-quant] and my t-cells were as high as 335 in october, 1999. recent labs reveal viral load is still <50, but the t-cells have dropped to 212. i don't know the %. [and by the way, what exactly is the significance of the percentage of t-cells].

i would say that, on average, my t-cells were hovering in the 190-225 range over the past several years, so i was gratified to see the 335 number last october. that test was about 6 months after starting the viramune/combivir regimen, which i tolerate quite well.

what is your opinion as to the fluctuating t-cells; is it simply that my immune system will ony restore to a certain level? and how potent are the t-cells that i do have. i guess the fact that, other than graves disease and chronic hepatitis-c, i am otherwise healthy, shows that my immune system is coping. is the drop in t-cells a trend, or could they just as easily rebound in the future?

thank you so much for your time and expertise; it is appreciated beyond words.


Response from Dr. Holodniy

Your CD4 count could be fluctuating or it could be a real trend. The percentage tends to be a more stable number over time. The absolute number is a function of your total white blood cell count (WBC) and lymphocyte count. Simply put if your total WBC is 5,000, lymphocyte count is 2500, CD4 percentage is 20%, absolute CD4 count is 500. If your total WBC is 10,000, lymphocyte count is 5000, and CD4 percentage is 20%, absolute CD4 count is 1000. The numbers can fluctuate because of the time of day the blood sample is drawn, the test was done at a different lab, other acute infections, recreational drug use, or perhaps hepatitis C.


3 years undetectable and cd4/950+
Undetectable VL with continued decrease in CD4

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