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Struggling Tcell count
Sep 29, 2004

In Feb 2000, I started on a regimen of Zerit, Ziagen, Sustiva and Epivir. My tcell count was always hovering between 550-1200 and always undetectable. Due to my fears about Zerit, in early 2003, I was switched to Videx 250MG, Viread, and Sustiva. I had some kidney reactions (high protein, high creatine) and my tcell slowly dropped and then I was switched to Videx, Emtriva, and Sustiva. My tcell still dropped to a low of 432 with with my percentage at 20%. The former regimen was from around Feb 2003 to Feb 2004 and the latter regimen from Feb 2004 to July 2004.I was the switched to Norvir, Emtriva, Reyataz, and Ziagen. I have remained undectable, but my tcell count has gone up to 492, and then just this week back down to 465. My % went from 22%, a month ago down to 20%, and just this week up to 24%. I am religious with taking my regimen. I exercise, eat pretty good, am 35, feel great, but I am concerned about the fact that my tcell seems to be stuck in the 400s despite my doctor telling me that this regimen should increase the tcells quicker then other regimens. Am I just being impatient, or could there be some other underlying problem going on? My kidney issues seems to have disappeared and my blood count on my last test was normal. I am also concerned that I am being tested every 4 weeks, but my doctor only chooses to test for either detectable or undetectable every other test. Is that normal? His reasoning was that if I have always been undetectable, testing every 4 weeks for that aspect of the test is unnecessary. Please respond. Its a little scary that my tcell seems stuck in nuetral when I had 4 years of tcells counts generally over 1000. Thanks for your time.

Response from Dr. Lee

As you know, HIV is a very complex disease state with many complicated interactions between the person, the medications, and the virus. I don't actually have a good explanation for why you may have had a drop in your absolute t-cell number and percentage despite good viral control. (Assuming that the viral test accurately reflects your viral level. An example of when that may not be true is if you have a non-Clade B virus- usually acquired outside of the US or Western Europe.) There are some studies that indicate some of the medicines are associated with a greater tcell response than others (most recently Ziagen or abacavir has been associated with a better t-cell response). However, there are interactions described with age, other possible medical conditions, etc. If your viral level remains undetectable you are on adequate therapy. You probably don't need to check the viral load quite so often if it has been stable. Run over these issues and your questions with your doc. Be well.



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