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Just Diagnosed
Feb 9, 2004

On 15 October I was diaognised HIV+.My CD4 cell count was 345 and my viral load was at 8000.With this is it possible to tell as to when i got infected with the virus. My previous boyfriend who I last had unprotected sex with sometime in March says he has tested negative.Is this possible? My dr has advised that since I haven't had any serious illness I should prolong going on antiretroviral..but I have read that it is suggested people having a CD4 of below 350 should consider taking treatment.With my CD4 count is it possible to stay healthy for long?

Response from Dr. Pierone

Thanks for posting. One is not able to back date and determine time of acquisition of HIV infection based on a current viral load and CD4 count. There is too much variability for any one person to come up with a clear answer.

Here is a theoretical example based on the numbers you have supplied: the average CD4 count is about 1000 and average rate of decline is about 100 CD4 cells per year. So we could estimate 6.5 years since infection. But this viral load is not average it is less than the typical viral load, so maybe the virus is progressing more slowly and the rate of CD4 loss is 50 cells per year. This would mean that infection had been present for 13 years. Not everyone starts off with 1000 CD4 cells, if the beginning CD4 count was 1200, that would mean infection occurred 17 years ago. And if the next CD4 count was 450 this would throw the estimates off again. The point is that this is often a futile exercise and seldom helps clarify the situation.

The risk of transmission of HIV through unprotected sex is low per coital act, but of course, the risk accumulates over time. A sero-discordant couple that have unprotected intercourse will have a rate of transmission of about 5-10% per year.

Even though your CD4 count is about 350 you should get at least one or two more determinations before considering therapy. Your viral load is low and the repeat CD4 count may come back considerably higher. If the CD4 count is consistently below 350, then therapy should be considered. It is possible to stay healthy for a long time with you current numbers and that is why treatment is often deferred. Eventually you will need to go on antiretroviral therapy, but that may be months to years in the future. Good luck!



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