Low Viral Load low CD4
Oct 24, 2004
I am a widower, got infected in 1999, was diagnosed HIV+ in Sep 2004 and have commenced treatment. Have low CD4 of 83, but low viral load of 2000. Have commenced Lamivudine+Zidovudine+Nevirapine since 23.9.04. Any expectations as to what to expect and when my doc should ask for a check on CD4 and viral load.
My wife has been recently diagnosed as HIV+. Her CD4 is 83 and viral load 2000. She has been initially started on Combo of Lamivudine 150 mg and Zidovudine 300 mg twice a day plus Nevirapine 200 mg. Is her low viral load a positive factor inspite of low CD4. Any issues about the treatment. She is not being given any preventive therapy for OIs. She has been previously untreated.
Response from Dr. Pierone
Well now, which is it, you or the wife? There are some gender specific differences that do impact selection of antiretroviral therapy and this seems a good time to address some of them. Nevirapine (Viramune) is more likely to cause liver toxicity in women with greater than 250 CD4 cells and in men with more than 450 CD4 cells. Sustiva, the NNRTI alternative to Viramune, is associated with birth defects in primates so must use used cautiously in women of childbearing potential.
Another aspect of antiretroviral dosing that does not garner much attention has to do with the differences in body weight between men and women. Since most HIV medications are not adjusted for weight we end up giving women (on average) higher effective doses of medications. So a 240 pound middle linebacker gets the same dose of Combivir and Sustiva as a 100 pound gymnast. Does this seem logical at all? In the future I think that we will be measuring blood levels of antiretroviral medication in order to help guide proper dosing. It is surprising that there is not more research being done in this field, especially since therapeutic drug monitoring is commonly used in other disease states.
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