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Low CD4, OK CD4 Count, Start Treatment?
Feb 25, 2004

Without going into a lot of treatment history, I have been positive since October 1999. I've never had any drugs bring my viral load down to undetecable and my last resistance test, Nov 03, shows I'm now also resistant to Kaletra, along with all the other drugs (Fuzeon was not on the list of tested drugs). Almost a year ago my doctors took me off meds completely since my CD4 count was in the upper 400's.

Since being off meds I've paid closer attention to my cd4. My viral load right now is 89,900 from my last test a month ago and is up 10,000 from 4 months ago. My CD4 absolute count has increased from 388 to 452 (In my mind I attribute some of that to the starting of drinking green tea). However, my CD4 was 17 4 months ago and now is 16.

I've read I should start prophylactic treatment to prevent infection once my CD4 is at or below 13, is that true? My docs are waiting until my absolute CD4 count drops below 350 to start me on meds, but I am worried about my percentage right now. As far as meds go, they are going to put me on Fuzeon, Reyataz, and two other drugs which they are unsure of right now given my resistance tests, based on the available meds currently.

Any suggestions on a start time or should I just wait until my CD4 count drops below 350 and not worry about my percentage at 16?

Response from Dr. Pierone

Since your overall CD4 count is high I would not worry about the low percentage. If the resistance test showed that the virus is resistant to Kaletra then Reyataz is not going to pass muster. In fact, you might strongly consider trying to hold off on restarting treatment for as long as possible (CD4 count <200). With multi-drug-resistant virus it is best to try salvage with a combination regimen with at least 2 highly active agents. If you can wait for Tipranavir or TMC-114 to use along with Fuzeon, that would make more sense. Since your CD4 count is good you should be able to. Actually, if you can wait even longer and obtain a CCR-5 inhibitor (phase 2/3 trials starting soon) to use as well that would improve your chances of a full response. Keep us posted and best of luck!



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