Falling CD4 despite VL < 50
Aug 25, 2000
I have a patient who has been taking Combivir and nelfinavir for 18 months. During that time, his viral load has been < 50 on multiple determinations, but his CD4 count has dropped from 220 to 130 with a corresponding decline in CD4%. Would you recommend IL-2, intensification of treatment, or some other course of action?
Response from Dr. Holodniy
Dificult problem. We have seen a few of these patients. I don't know the right answer. Changing regimens didn't seem to help. That is my anecdotal observation. It would not be unreasonable to try IL-2. However, something tells me that there is some reservoir in which therapy is not getting to the virus and cells are actively replicating virus, which in turn is further killing CD4 cells. That might mean that IL-2 administration might trigger further replication in these sites. Pure speculation. MH
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