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CD4 and VL?
Jul 2, 2004

I found out I was positive in March 2004 and in April my CD4 was 465 (31%) and VL 7348. In June my CD4 was 336 (28%) and VL 2307. I get my next labs July 1, 2004. Would you recommend starting treatment and is it normal for both the CD4 and VL to drop. Does the drop in VL mean that my immune system is still fighting? Any info would be greatly appreciated. Thank you in advance.

Response from Dr. Pierone

It is not unusual for the CD4 count and viral load to go in different or the same directions, they often march to the beat of different drummers. They both can vary considerably, which is why it is important to have multiple determinations before making any decisions with long-term implications.

In your case, the low viral load indicates that your immune system is fighting the virus well and this is an excellent sign. The best time to start therapy is not known, but generally we often recommend treatment when CD4 counts are in the 200 to 350 range.

The decision to start treatment should be carefully considered and depends on many individual considerations. Foremost among these issues is readiness. A person must be truly prepared to commit to daily medication and full adherence; otherwise there is a risk of developing viral resistance which can limit future treatment options. We see this too commonly, someone with decent numbers go through a series of regimens with lackluster adherence and after several years they have developed resistance to virtually every medication. Some of these people would have been fine just being followed off therapy. This risk of resistance is just one of the challenges of treatment; drug toxicity and cost are additional considerations.

Coming back to your situation, with this very low viral load you can likely hold off on therapy now and probably for quite some time. See how the numbers look over the next year to get a better sense of trend. Good luck!



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