Dec 17, 2004
Thanks so much for your work on this forum. It is very informative and reassuring.
My situation: I have had consistently normal cd4 counts (600 - 700) and my viral load has been consistently under 5000. My cd4% however has been steadily declining particularly this past year and now is hovering at 20%. My doc is now starting to think about initiating treatment, especially if the percentage drops any lower. Does this make sense to you? I am also concerned that with such a low viral load to start with, will further supression of HIV really make a difference in my counts. Thank you very much in advance. You really provide a great service.
Response from Dr. Young
Thanks for your question and kind words.
Declining CD4% is a concerning issue, even when your total (or absolute) CD4 count remains in the normal range. I typically begin to think about recommending starting treatments with CD4% that are below 20%-- consistent with your doctor's recommendations.
Many people have the misconception that having a lower viral load means that they can't have CD4 declines. This isn't true. Lower viral loads simply predicts that the rate of decline tends to be slower than average, but doesn't mean that decline can't or won't happen.
Suppression of HIV viral load (or HIV replication) should (and certainly has in my patients) caused a significant increase in CD4 cells (or CD4%). Having a lower viral load might suggest that the likelihood of acheiving an undetectable viral load might actually be higher (or "easier").
Good luck, let us know what you decide to do..
Thanks for reading, BY
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