A Thai experience
Aug 14, 2004
My friend just know he is HIV+ .CD4 286 (12%) and No viral load test available in Thailand.Routine blood test all normal (WBC 5.8).He confirmed that his infection is within 18 months as he checked HIV negative 18 months before. Dr in thailand now precribed contrimaxazole daily, withVitamin B1, 6, 12 and Vitamin C and Folic acid daily, plus weekly dose fluconazole 200mg He don't have any visible symptoms now,lymph nodes Ok, no diarrhea and skin problems. It is controversal to use antiviral drugs to patient with Cd4 200-350, but it seem that his CD 4 is low . I don't know his CD4 was affected by the emotional upset during the few days he just tested positive.AS i know cortisol under stress might increase 20 folds that could reduce the Cd4 level. But i want to ask exercise and living with less stress can really increase the Cd4 count even without and antiviral treatment.
I only have one case for my reference, A chinese guy that test positve on May 2003 , then test CD4 every 3 months and the result was 268-->226-->298-->328 up to one year I am not sure this guy's low Cd4 during last year is due to stress or without any correlation.
Hoping that experts from States can give me some opinion to help him.
Response from Dr. Young
Thank you for your question.
A variety of factors can cause small changes in CD4 counts-- stress and other factors that influence cortisol among them.
No, that said, it would be medically prudent to assume that the low CD4 count is a true low CD4 count, rather than to hope that the numbers might otherwise be higher-- at least until proven otherwise (in this case, by repeating the tests). The fact that your friend's Thai doctor has prescribed trimethoprim/sulfamethoxazole (Bactrim)indicates that the medical opinion is that there is significant immune deficiency. A CD4% level of 12 is, on average, equivalent to a CD4 absolute (total) level that is below 200, consistent with the prescription of preventive therapy with Bactrim.
If your friend were a patient in the US, I would be offering antiretroviral therapy. BY
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