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re: persisently low CD4 but is it a problem?
Oct 29, 2009

Hi there,

Thanks for answering so rapidly!

Just to clarify, I was on DRV(r), 3TC, AZT and TDF. CD4 was 155 (32%), dropped AZT, CD4 went up to 204 (19%). Latest: CD4 176 (22%). Explain? !

Also, I was interested in your views on the long-term effects of persistently low CD4 counts for otherwise very fit guys like me...... should I worry about malignancies?

Thanks again. M.

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   Response from Dr. McGowan

Thanks for the follow-up.

I am not too worried about this progression. As we discussed the 32% is out of line with the 155 total CD4. Otherwise it is a good progression. Your should hit 200 soon.

There is a difference between having a low CD4 count with active HIV versus suppressed HIV. HIV itself causes alot of inflammation (activation) of the immune system that in and of itself causes damage to organs. Over time on treatment this activation should go down and would lower your risk for diseases. Cancer risks are always a bit more muddied because it can take years for cancers to develop and most of the studies we have on cancer risk with low CD4s were in people who did not have their HIV suppressed...so I would not worry too much, but stay in care and get screened and keep on top of your health.

Best, Joe


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