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2 months of treatment follow up
Dec 28, 2003

Hi Dr.!

I have posted messages and gotten straight-up, sincere and honest responses from you. Id like to ask you to do the same again. I had my bloodwordk after 2 months of treatment and although the numbers are not discouraging at all, I have a serious concern and a doubt that Im certain you could help me clear up

Before treatment (Combivir/Sustiva) my numbers were: VL: 5 Million CD4: 19 After a month: VL: 5,000 CD4: 149 After month Two: VL: 789 CD4: 103

As you can see the VL keeps decreasing and I was expecting the CD4 to increase as it was the case during the first month of treatment. My Dr. assures me theres absolutely nothing to worry about and that is TOTALLY common for CD4 counts to come down before they increase again and that the result over time would be higher and higher CD4 counts Is this true? Have you had the same experience with your patients?. I believe and trust my Dr. a lot but he seemed closed to the posibility that maybe my inmune system is so damaged that it just cant regenerate itself anymore that it has, in spite of the decreasing VL (which is a sign that theres no resistance at this point, right?)

The next day after withdrawing the blood I had my first chemo treatment (Doxil) for my KS and the lessions are less painful now and I have not gotten new ones in the last 2 weeks.

Any comments at all or sharing of your experiences in treating and monitoring patients progression will be very much appreciated

Response from Dr. Pierone

Hi and thanks for the update on your status. It is expected for CD4 cells to fluctuate quite a bit so the decrease in your CD4 count at month 2 is really not of concern. Almost no one on therapy has CD4 cells that only go up, there is always some zigzagging related to the natural ebb and flow of CD4 transit in the bloodstream. The CD4 percentage or CD4/CD8 ratio is often less variable than the total CD4 count is.

The fact that you CD4 count jumped over one hundred cells after only 4 weeks indicates that your immune system is well able to regenerate. After the first phase rapid increase in CD4 cells, the subsequent increase slows down so it may take several years to see CD4 cells in the 200 to 300 range (although everyone is different in this regard). As long as the viral load continues to decline there is no reason to suspect development of viral resistance. When the original viral load is very high it may take as long as 6 months (sometimes longer) for it to become undetectable. Good luck!



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