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Which is more important?

Mar 23, 2004

After being diagnosed with HIV almost two years ago with a CD4 count of 34, my CD4 count, after starting treatment, went as high as 154. My most recent lab was 121. The last 3 labs have showed a decrease in my CD4 count from my high of 154. The viral load has been undetectable in all my labs. My doctor says he's pleased the viral load has been staying undetectable. In your opinion, is the viral load more a concern of doctors than CD4 count? I'm currently on Viread,Sustiva and Epivir. Thank you.

Response from Dr. Boyle

Unfortunately, not all patients get a brisk immune recovery, despite what appears to be excellent HIV suppression. The reasons behind this are unclear, although some studies indicate that starting later, older age and HCV infection may be associated with a blunted immune response to therapy. Your doctor is right that it is good that HIV is suppressed in the plasma, but it is not good that your T cells remain <200 despite that good viral response. Your doctor may consider of trial of adjunctive therapies (e.g. IL-2) or regimen intensification to see if that helps. You should, of course, still be on PCP prophylaxis, and, if you're not, you should restart ASAP.

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