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pml
Apr 1, 2003

Its now two years since I was diagnosed with hiv and suspect pml and a cd4 count of just 9. Now my cd4 is 368 and my viral load is undectable, so things are looking good, how am I doing with these numbers and what should the trend now be for me, can I make plans into the next couple of decades. My cholestrol levels are very high due to combiver ( I suspect) and nevaripine which i am taking, which combination should i switch too. Many thanks for your time and your professional advice is very much appreciated.

Response from Dr. Young

Thanks for the follow up..

Would look like (at least from the labs) that you're doing great. A CD4 increase from 9 to over 300 is fantastic-- the kind of improvements that many of our readers need to hear about.

As for the cholesterol, none of the medications that you're taking at the moment (ZDV, 3TC or nevirapine) are thought to be significant culprits in raising cholesterol levels. As such, I'm not sure that a switch in this otherwise successful treatment would improve this one aspect of your medical management. Looks like a review of your diet, exercise, smoking habits would definately be in order. If this is optimized, you might be a candidate for cholesterol lowering drugs, like a "statin".

I'd wager that your long-term prognosis is excellent, forecasting decades is tough, but looks like you'll be there. Adherence will continue to be the hardest part of things, though this far along, would appear that you've got it figured out. As for other long-term "complication" issues, we'd continue to monitor you for these-- your very low CD4 count nadir might put you at greater risk for some types of complications, particularly lipoatrophy. Unfortunately, this is not a modifiable risk factor, so we'll just have to monitor. There's concern about increased risk of cardiovascular disease among our patients (reflected in your question about cholesterol). While controversial, it would seem plausible and worth evaluation and appropriate behavioral modification (like smoking cessation) and medical treatment. Ultimately, the program largely remains the same-- continued monitoring, continued follow up visits and hopefully, further improvements in medications.

Good luck, BY



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