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Low CD4 with Low VL in First Year of Infection?
Mar 5, 1999

My HIV test results of Feb. '98 and July '98 were negative, but my Feb. '99 HIV test came back positive. A follow-up HIV panel showed my CD4 at 383 but with viral load around 650. Isn't such a low CD4 rather unusual in the first year of infection? What would account for that? (I took the July '98 HIV test after experiencing a severe summer flu the last week of June, which my doctor suspects was symptomatic of seroconversion. Is it possible that an HIV test a week later would be negative if that were true?) My doctor wants me to begin Sustiva, Zerit and Videx ASAP because the CD4 is below 500, but with such a low viral load, would it hurt to wait to begin these treatments?

Response from Dr. Holodniy

The CD4 count is on the low side, but well within the range of folks I have seen following acute infection. You didn't say what kind of HIV test you had in July, but an antibody test could certainly be negative following symptoms in June. Your situation is somewhat different than someone with a viral load of 650 and 650 CD4 cells, in whom I might wait to start therapy. Your infection indicates some immunologic damage, despite the low viral load. I would agree with your doctor and the regimen recommended. MH



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