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Chance of being nonprogressor
May 7, 2003

Hello, I recently tested positive (I tested negative in July of 2001) on April 2 and my first lab results were a viral load of 107779 and CD4 of 603. Is this a good test and is there a possiblility of me being a non-progressor? Ultimately, should I start treatment? My doctor says that I will have more test done in two weeks and unless it shows that I have a recent (6 months) infection, I will most likely not start treatment. Thanks for your advice.

Response from Dr. Young

Thank you for your question.

Your CD4 count is quite good and in the normal range. Your viral load of 107,000, on the other hand is higher than average. We believe that a high viral load is an indicator of having faster than average decline in CD4 numbers. As such, I'd think that it is rather unlikely that you'll be a long-term non-progressor.

Your doctor is correct in the statement that acutely infected persons have very high viral loads, and this could readily explain your viral load. However, if the tests don't confirm the acute stage, then your viral load would be indicative of your viral "setpoint".

Starting therapy becomes a more complex decision, and those with the highest viral load do have a greater risk of progression to an AIDS event within the next several years. As such, the current guidelines discuss starting therapy in persons with viral loads greater than 55,000. In our day-to-day practice, I rarely use viral loads alone as the basis for initiating therapy, but rather use the CD4 count as the trigger to start. Viral loads, on the other hand give me information about how closely to monitor- and how to counsel patients about when it is likely that they'll need to start.

Good luck. BY


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