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HusbandHIV+ and WifeHIV- III
Dec 20, 2002

Dear Dr. Benjamim,

My husband wrote for you on Aug 24,2002 and I wrote the second letter on Aug 28,2002.

The initial results in September 17, 2002 was:

RED BLOOD CELLS

RBC 5,03 , Hemoglobin 14,9 , Hematocrit 44,7, Average Vol.Glob 88,9 fl, Average Hem. Glob. 29,6 pg, Average C.H. Glob. 33,6 g/dL, RDW -CV 12,8

WHITE BLOOD CELLS

WBC leukocytes 4,400, basophils 0, eosinophils 44 or 1,neutrophils 3,080 or 70,lymphocytes 1100 or 25,T4(CD3+/CD4+) 264 or 24, T8(CD3+/CD8+) 726 or 66, CD19+ 44 or 4, relation (CD4+/CD8+) 36, monocytes 176 or 4

Platelets count 213,Total Cholesterol 193, LDL 137, VLDL 24, HDL 32, triglicerides 120 , blood sugar 101, hemoglobin gl. 3,8 and VL (PCR) 24,300 log 4,38.

My husband started the treatment on Oct 1,2002. The adhearence is 100 and he takes all the meds on time. The therapy is 3TC(300 mg) +AZT (150 mg)/ two times per day - 10:00 AM and 10:00 P.M.; and EFV Efavirenz (3 X 200 mg) 10:00 P.M.. On Dec 12, 2002, the results are:

RED BLOOD CELLS

RBC 4,31 , Hemoglobin 14,0 , Hematocrit 42,4, Average Vol.Glob 98,4 fl, Average Hem. Glob. 32,5 pg, Average C.H. Glob. 33,0 g/dL, RDW -CV 22,9

WHITE BLOOD CELLS

WBCleukocytes 3,300 , basophils 0, eosinophils 33 or 1,lymphocytes 1287 or 39, T4 (CD3+/CD4+) 347 or 27, T8(CD3+/CD8+) 837 or 65, CD19+ 51 or 4 4,relation (CD4+/CD8+) 41 , monocytes 264 or 8

Platelets count 207 Total Cholesterol 233, LDL 165, VLDL 26, HDL 42, triglicerides 130, blood sugar 94 , hemoglobin gl. 4and VL (PCR) undetected.

1)Please comment in details the results 2)He has not side effects, but it is not commom solid excrements, we wouldn't call as diarrhea, sometimes are normal and solid. 3) Which are the next steps? Concerned, take attention,... 4) Tell us about the evoluation, is it possible to reach CD4 as 1500 (58), how long should we expect?

I just wanted to say thank you so much, you are a good angel. On the next letter I will talk about my situation. I will keep in touch.

Response from Dr. Young

Thank you for your detailed question.

Your husband's labs show a nice increase in CD4 cell absolute count (from 264 to 347) with a similar increase in another measure of CD4 cells, namely CD4 cell percentage (from 24 to 27). There has been an excellent viral load response with a baseline viral load of abouit 24,000, now undetectable after roughly 3 months. This is an excellent indicator of the potency of the drug regimen against your husband's virus, and suggestive of very good long-term response to therapy.

There aren't any other significant abnormalities in the red- or white blood cells; there has been a modest increase in total cholesterol, but appears to be driven primarily by increases in the "good" cholesterol, called HDL.

Overall, things look very good, and I wouldn't suggest changing anything, only to continue to be very vigilant about adherence and monitoring for side effects.

The next steps are to continue taking medications and get routine laboratory and clinical monitoring. As for a CD4 count of 1500-- this might be a little too much to expect, since this value is actually higher than the upper limit of normal for many persons. By the way, a CD4 count of 350 is actually the lower limit of "normal" in our laboratories. Nevertheless, achieving normal CD4 and CD8 cell levels can be achieved in some persons. Even if this does laboratory goal does not occur, significant improvements in immunological health and quality of life can occur.

Good luck, BY



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