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Dr Cohen, pls help!
Apr 21, 2002

Dear Dr Bob, I was tested positive last week in a public hospital. A week prior to that, I got myself tested in a private lab, which also resulted in a positive status. On both occasions, I did Hep. A, B, C and CBC test along with the HIV test. My fear now is within the period of a week, my WBC dipped from 8.4 to 7.6 and my lymphocyte dipped from 25 to 22. I will not get my CD4 and viral load count until a month later when my next visits is due. I'm worried of the sudden dipped with my WBC and lymphocyte. Is such fluctuation normal especially within a period of a week? Does it mean that my disease is progressing at a rapid rate? I've learned that the lymphocyte does represent my CD4 count, which means it is declining at a rapid rate. I have tried asking for an earlier schedule but was told by the Dr that it is not possible as there are lots of patients that need to be treated and judging by my physical appearance, he said that I should be all right for the next few months and ask me not to be too worry BUT damn it! I'm dead worried. Frank G

Response from Dr. Cohen

Frank - lab tests, including the white count and lymphocyte count will fluctuate. And the little fluctuations you describe are normal and tell us nothing about the rate of progression of illness. In general, progression of HIV happens pretty slowly - these changes in a month are almost never predictive of changes caused by HIV.

Our bodies will have many fluctuations within the normal ranges. This is something to get used to - since the Cd4 counts will fluctuate along with these other counts. Which is one reason why sometimes we need to look at the CD4 percent - another way to measure the cell counts, with less fluctuation. Similarly the viral load can bounce a bit - usually within a range of two fold - meaning if you had it done twice in a month - it might be 10 thousand one time, 20 thousand the next and we would consider that the same thing.

So get the real numbers - and find out what is going on. These minor bounces don't tell you what you need to know - and your anxiety isn't helping to get you the info you need. And then just know that small bounces are normal and what bounces down a bit, can bounce back up on the next test...

PS not sure who Dr Bob is, but signing off, is Dr Cal....



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