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Young With AIDS - Older with only HIV infection?
Dec 31, 2003

I have met "recently infected" people who are very young and have AIDS. People so young that you would not think they had time, the 8-10 year time span, within which the onset of AIDS is thought to occur. I am 33y/o and have been infected since 10-01. At the time my cd4 was in the thousands and my viral load about 25,000. Then my numbers went crazy with a sharp drop ( 400 cd4 (can't remember the vl all within six months))which led to an eight month treatment regimen. My numbers shot way up as far as cd4s (back into the thousand area) and my viral load went down to the ten thousand range, then to zero (undetectable). Because of side effects I was taken off meds. It has been a year now since I have been off meds, my last cd4 was about 600 and my vl was about 10,000. I have seen a slow, gradual decline in CD4 yet the viral seems not to move around too much and if it does it decreases a little. My questions are - How is it that people so young can reach the AIDS CD4 numbers below 200? If they are capable at such a younger age of reaching those levels what prevents me from taking a nose dive? I now know that my CD4s can show lower than they are and that results have to be reconfirmed, but I have only seen a decrease in cd4 since coming off meds, I have yet to see a plateau. Is this normal? Will I plateau? ( I know you realy cant' answer that - but is there the possiblity that that will occur? Is it part of an expectation that I should have? or should I expect a slow and gradual decrease in CD4) What if anything would make me dive-bomb into AIDS levels? I sometimes feel panicky and wish I were on meds and then when I think of all the side effects I had, I become conflicted.

Thank you for all your efforts - they are greatly appreciated.

Sincerly

Rob Living in the Twilight before treatment.

Response from Dr. Pierone

Hello Rob, thanks for posting. Some people with HIV infection mount a weak immune response to the virus, have high viral loads, lose CD4 cells rapidly, and progress to AIDS much faster than the average 10 years. Others have relatively stable numbers, low viral loads, and gradually lose CD4 cells. Occasionally, viral load will spike to a high range and CD4 cells will plummet in otherwise stable individuals. Sometimes an infection or stressful immune stimulating event will cause a perturbation in numbers like you experienced. Very rarely, superinfection with a new strain of HIV has been implicated in a spike of viral load.

In your case, the expectation would be for a gradual decline in CD4 cells during the time that you are off medications. Especially since you had side effects on therapy it would probably be best to stay off treatment as long as CD4 cells remain above 350 and viral load stays below 50,000. Let us know how things turn out and best of luck.



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