Hi Doctor Benjamin,

Thanks so much for all that you do here I can only imagine the amount of emails you get and you actually reply to so many while still being in practice. It hardly seems possible.

I have recently chosen to start meds and I have started Atripla. After 10 years of no meds my vl on last test was 23000 which I understand is in the low range but my cd4 count is extra low as well. I have been told that there is no real connection between vl and cd4. My questions are this... If you don't need a very high vl in order to wreck your cd4 cells down to 23 then how can we assume that by pushing my vl down to undetectable that my CD4 cells will raise up much higher than they are if there is no real connection?

I have chosen Atripla as my drug of choice being that I am not resistant and I have all confidence that it will get me to undetectable but it's hard to imagine how it can have any real effect on my cd4 since my viral load is so low to begin with. Secondly when you are undetectable you are constantly told that you still can pass the virus on. Is there LESS of a risk once your VL is undectectable?

Thank You

Thanks for your post and thoughts.

You clearly don't need a high viral load to see CD4 decline, but I wouldn't confuse low with a count of 23,000 -- this is a quite typical or average value. So-called average HIV viral loads definitely result in CD4 decline, AIDS and, yes, death. So, there is a connection and treatment is very much indicated.

Once undetectable, I'd entirely expect your CD4 to rise and your viral load to reach undetectable levels.

As for the transmission question, your risk of passing the virus on drops very much with lowering the viral load. It's tough for this American doctor to say that the risk is eliminated (too many lawyers lurking out there), but it does go down dramatically (this is why we aim for the same goal among pregnant HIV+ women).

Best of health to you, BY