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Nonprogressor ?
Jul 21, 1998

Dear Dr. Holodniy,

my girlfriend is HIV infected for at least 4 years now. So far, she has no symtoms and appears to be healthy.

In October 97 she got tested (the first time) for viral load and CD4 count. Her VL was <500 and CD4 count was 840.

The next test after 6 month (April 98) was VL <500 and CD4 count of 1133. She had never received any treatment

but she is taking some vitamins for about a year now.

How is it possible that her CD4 count is rising in the absence of any treatment and how high are her chances of getting AIDS within the next years ? I read in a study that if CD4 count is >750 and VL is <= 500 the likelihood of getting AIDS within the next 9 years is about 3.6 %.

Do you agree with that and is her high CD4 count usual or common in other patients after 4 years infection ?

Is she considered to be a nonprogressor ?

Thanks a lot for your time.

I really appreciate your help.

Response from Dr. Holodniy

You are to be commended on your homework! Although it is still early in her infection, that viral load and CD4 count would indicate slow or no progression. This may be related to the viral strain she was infected with or her immune system and genetic makeup. Based on some long-term followup studies, the likelihood of developing AIDS is very slim. A small percentage of HIV infected patients are long term survivors (long term nonprogressors) and have CD4 counts >500 for 10-15 years with undetectable viral loads. Given her trend over the last 4 years, she may be a nonprogressor. She still requires periodic CD4 and viral load testing. CD4 counts at that level can have wide swings. I would look at the percentage of CD4 cells as more stable number over time. MH



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