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CD4 Count - Dramatic drop, indifferent doctors
Oct 19, 2004

Hi,

My partner (Billie) was diagnosed HIV+ in August 2001. I am HIV-(last tested May, 2004) Billie's CD4 was approx 650 at the time, recent tests have been 04.2003 approx 550, 01.2004 approx 770, 09.2004 approx 175.

This is a dramatic drop that I can't begin to explain or understand as Billie eats well, exercises regularly and aside form the very occasional common cough or cold (in season) outwardly appears healthy.

She has this week started to develop shingles - the second time in four years and she has spoken to her (Thai) doctor about her recent results who seems very indifferent.

I know that she must start medication immediately and we plan to see her doctor - who is not an expert on HIV infection (but will ask a friend?)on 27.09.

Billie is Thai and we live in S'Pore.

Without exception, every time we have spoken to a doctor in Thailand (even the HIV experts), they have been unsympathetic, fairly unknowledgable and of little help quite frankly.

They have more concern over Billie's ability to pay than offering advice and support -

Can someone please advise me what type of drug regime that they should be recommending for Billie as a first line?

Can someone please advise me what I can expect to see in then next few months regarding Billie's overall health and responsiveness to treatment?

Can someone please advise me of the frequency of testing that Billie should be having moving forward to ensure that her viral loads are under control and that she is repsonding to medication?

I speak Thai (but not to the level required to have complex medical discussions)and most Thai doctors have quite poor English - so our problem is exacerbated by language barriers.

Treatment in Singpaore, regrettably, is not an option.

Please help - I need a check and ballance in order to help me deal with the doctors in Thailand next week

Thank you in advance -

Response from Dr. Pierone

It sounds like you are trying to navigate a very challenging healthcare situation. Based on the drop in CD4 count and recurrent shingles it does sound like treatment is indicated at this time.

The initial regimen depends on what you have available. Most patients in the United States are begun on a NNRTI-based regimen (Sustiva most commonly) because of convenience and fewer side effects. The response is typically very good with about 70 to 80 percent of patients achieving an undetectable viral load within 6 months. The CD4 counts increase as the viral load declines. There are more frequent office visits in the first 6 months to monitor for side effects and to verify the expected outcomes. Then we often see patients every 3 months for labs and follow up is all is going well.

Best of luck to you and Billie, let us know how things go.



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