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alarmed at variance in results
Nov 9, 2003

Doctors,

I'm an American living overseas and get great HIV care from my specialists in Germany. I tested positive in Mar 00 though I'm sure I was positive well before that. Since then my CD4 count has been between 400-500 and VL anywhere from 4000-70000. I'm not on meds and my last results this week revealed a drop of CD4 to 169 from 359 in May and 434 in Jan. My VL was 2100 this week compared to 70000 in May and 19000 in Jan. My numbers appear to be all over the place with no apparent pattern that I can see except a drop in CD4 the last 2 times. The German doctors chose to not start treatment until the CD4 drops to below 200 for a period of time (2 or more occurrences concurrently). What would cause such a blip in the data to a CD4 of 169 but with VL the lowest in 3 years? At what point should I consider meds....I'm waiting for new results in 2 weeks. The doctors don't seem that alarmed at the difference since over time my numbers have been fairly good and they said several other patients showed very low CD4 counts in May. Also, I recently got a flu shot and am concerned that may lower my CD4 count from my latest blood results. Appreciate your expertise and advice.

Thanks

Response from Dr. Wohl

Your numbers, particularly your viral load, do seem to bounce around more than one would expect. A swing in your viral load could be due to lab error or possibly to a true increase in your plasma HIV RNA levels. The latter can occur secondary to vaccination or illness. This is usually a tranisent increase although, if high enough or prolonged, it can drop your CD4 cell count.

The other parameter to pay attention to is your CD4 %. The is different than the absolute CD4 count you reported. The CD4 % indicates what proportion of your white blood cells (WBC) were CD4 cells the day of the blood draw. WBC counts vary and if on a given day they are relatively low, your absolute CD4 count may look low but if the CD4 % has not changed much, all is probably well and next time the absolute may well be back up.

A re-check of your counts make sense. If there is a trend in your CD4 cell counts, then I'd believe it. As you know, here in the US we tend to start treatment a CD4 cell counts of 300-350. In Europe it is 200. You can talk with your doctors and see what they are comfortable doing given the results of your up-coming labs. DW



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