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tcells decline but viral load remains constant
Jan 14, 2005

I have been hiv positive since 11/1999 and have yet to start meds. Since that time my viral load has remained between 2000-10000 but my tcells have gone from 618 to 218. As of two weeks ago my tcells were 218 and my viral load was 4000. Next week they are retesting my tcells to ensure they are that low but they have outlined a treatment should I need to start. They have recommended Sustiva and Truvada. I have two questions. One, if my viral load has remained so low why have my tcells declined so much? And secondly how is the treatment that my doctors want to start me on?

Response from Dr. Young

Thanks for your post.

There appears to be some confusion over whether persons with low viral loads will have CD4 cell decline. As your case illustrates, the answer is clearly yes. (Indeed, I have some persons who have similar CD4 cell declines whose viral loads are never above 1000.) A low viral load predicts (but by no means proves) that the rate of CD4 cell decrease will be slower than average, but this is only a prediction. If your low CD4 count of ~200 is confirmed, I would certainly support starting treatment.

The regimen of Truvada with efavirenz (Sustiva,Stocrin) has garnered a lot of recent attention with the initial presenation of the Gilead 934 clinical study-- the 24 week analysis of this study was presented at last year's ICAAC meeting by Professor Gazzard, from London. These initial results are very encouraging, with a greater number of persons with treatment success than those who started on the highly recommended regimen of Combivir (AZT/3TC) with efavirenz. The major differences in the two regimens was the tolerability of the later treatment, with a greater number of persons having to discontinue Combivir because of the well characterized side effect profile of AZT-- mostly due to anemia. For those persons who remained on treatment (presumably tolerating medications), there was no apparent difference between Truvada and Combivir. Truvada's component drugs, tenofovir and FTC are relatively newer medications on the landscape (especially FTC), but save for persons with preexisting kidney disease, has not raised any significant safety issues. Truvada plus efavirenz should prove for your to be a very well tolerated, easy to take drug regimen- with only two pills taken once daily.

Good luck, keep us posted as to how you tolerate your medications. BY



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