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When to start meds
Oct 6, 2003

I have been hiv four years. My tcell average about 450 viral load 11000. Over the last six months my viral load has gone up to 67000 and my tcell is at 20. I am not sure what is high or when a person starts meds. My Doctor wants me to start after he get's my labs back in two weeks. Can you help. THANKS

Response from Dr. Pierone

It is very unusual for someone to go from 450 T cells (CD4 cells) to 20 over the course of 6 months. Could there be a lab error or report error? If you have had several lab tests documenting the decline in CD4 cells that would confirm that it is a real change in status. If only one test result has shown the dramatic decline your doctor is probably repeating it to be sure.

A rapid drop in CD4 cells with increase in viral load may occur when virus changes from R5 type virus to more virulent X4 virus. The X4 virus induces syncytia formation in which infected CD4 cells clump together with other HIV-infected and un-infected cells to form a multinucleated giant cell. This phenomenon explains why some individuals with HIV have a relatively benign course off treatment and then progress more rapidly.

But again, your situation is extremely unusual; see what the repeat numbers are and let us know. Good luck!

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