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Improved CD4?
Nov 28, 2004

Dear Dr. Young

My wife's baseline CD4 was 83, viral load 2071, CD4 12.8% in Sep 2004. She started on 24.9.04 on AZT, 3TC, and Nevirapine. She has been 100% adherent. Here in India, doctors monitor routinely through complete blood count. CD4 tests are performed every 3-4 months. Her latest blood test on 13.11.04 reveal a white blood count of 4010, and a lymphocyte % of 33.4%. Thus, total lymphocyte was 1340. Thee one previous test indicated a lymphocyte count of 1200. This is her fourth blood test result and her total lymphocytes have been in the range of 1200-1400. Her total lymphocytes in May 2004 (pre-treatment) were 900. Does the improvement in her lymphocyte count indicate progress. Secondly, if we assume unchanged CD4% of 12.8%, is it safe to assume that with a lymphocyte count of 1340, her CD4 would be around 160-180. Thirdly, what can of conservative improvement in CD4% can be expected after 8 weeks of treatment.

Response from Dr. Young

Thank you for your questions.

While I typically use a more direct measurement of CD4 cell counts, one can get a rough estimate of CD4s by examination of the total lymphocyte count, as you suggest.

In your wife's case, the improvement in total lymphocyte count is suggestive of improvement in CD4 counts. It is also reasonable to suggest that there might also be improvement in the CD4%, perhaps by 1-3% in the first two months of treatment, yielding an extrapolated CD4 absolute count that is actually closer to 200.

The key thing in these calculations is to understand that these are estimates, rather than true measurements. Nevertheless, the trends that you report are indeed, very encouraging.

Keep us informed of your wife's progress. Good luck and good health. BY

Proposed 2nd Regimen after some resistence.

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