First I want to thank you for your previous answers. I can't tell you how much it means to have this resource.

I am a former patient of your colleague, Dr. Castillo. When Dr. Castillo left southern NM there were no other ID specialists in this part of the state. I have been seeing a GP since then, and like her very much but had a question about a possible change in medication that might have a more positive effect on my immune health.

I wrote several weeks ago, and I know you must be very busy and can't necessarily answer every question. My primary concern, even though my numbers are good right now, is that my CD4% has fallen 4% in each of the last two quarters (from 33% to 25%) while my actual count went up (553 to 642) in the same period. It has been the "pattern" that every time my count goes up my percent goes down and vice versa. I've been on Atripla, without missing a dose, for 17 months. My only health issues are elevated lipids and weight loss (138 to 109 last year, now at 118 lbs, at 5'-8").

When you have time I hope that you might be able to look at my original email and provide a short answer. Are there better medications for someone in my situation? Is my response to the Atripla about what I should expect at 54 yrs old? (CD4 rather flat but still pretty good and VL undetectable). I'm staying on my meds and trying to take care of myself. Hope to hear from you soon.

Thanks again

Hello and thanks for your follow up from our neighbor state,

First, it seems like your doing well overall and your undetectable viral load is most important in this regard. It's also good to acknowledge that your following both your CD4 absolute and percentage numbers. The immediate trends are indeed, somewhat confusing to me, but not alarming. At age greater than 50, it's to surprising to not see dramatic increases in CD4s (several studies make this point).

I wouldn't be recommending any particular change in your regimen at this point; others have suggested that a boosted PI or integrase regimen might result in small increases (~50 cells) in CD4, but I don't believe that these differences are of clinical significance.

I hope this is of some help and look forward to hearing back from you,

BY