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Undetectable on HU and DDI
Aug 12, 2001

Dear Doc

I write from Zimbabwe! I am a black male 32yrs old.

I have known of my HIV + status from 1998 and at that point my VL was around 56000 copies. I went on DDI and HU in June 1998 400 mg DDI and 500mg HU twice a day.

My VL dropped to 568 in December 1998 with CD 4 1100 and to 64 in March 1999 CD 4 1280. In June 1999 VL Undetectable CD 1211, and since then my VL has been undetactable since. My results in July read VL undetactable and CD 4 1456 CD8 1821 and CD 3 3053.

I have been feeling fine but I have the tingling sensation and pain in the abdorminal. My amalyse readings were with range.

My question are * The CD4/CD8 ratio has always been reversed (0.8 in July 2001). What does this mean?

*Would it be OK to take a drug holiday to detoxify and observe what happens.

* Is my condition within conteporal resoning on HIV management. I was expecting mutations bouncing VLs and a steady downward trend in CD 4 especially on this Momo therapy combination?

Its a long question Doc but you happen to be well resourced with knowledge. I have to help my doctor with the technical content of maintating and managing the diesease. There isn't much documented information around.

Thanks

MUDDY

Response from Dr. Holodniy

The CD4/CD8 ratio in HIV uninfected people is usually 1-1.5, meaning that there are usually a little more CD4 cells than CD8 cells. HIV infection results in 2 things happening, infection of the CD4 cell resulting in a decrease in those cells, and increase in CD8 cell count. By changing both numbers (decreasing CD4 and increasing CD8), the ration normally goes down with HIV infection. You have had a great response to ddI/HU. There is no consensus expert opinion or clinical data to suggest what you should do next. Given your CD4, it is not unreasonable to try a treatment interruption and see how well your immune system can handle the virus on it's own. On the other hand you can't argue with success. MH



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