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Waiting to start meds
Jan 16, 2005

I was recently diagnosed a few months ago. I am 24 years old. My doctor and I believe that I was recently infected and we have agreed that I wait to get on meds. My numbers the initial time was vl=6200 cd4=274. So then my next test (2 months later) showed vl=1610 cd4=245. We both agree if my cd4 drops any lower we are starting meds, but we are primarily waiting for the release of the second set of cd4's. My cd8's are 931, which make us even believe further that it is the initial stage and my body is still fighting the virus, and we have no way to establish what my cd4 count was before I was infected. I show no signs of the virus, and I have been put on bactrim (sulfamethoxazole) once a day to prevent opportunitistic infection. I have been reading some posts and people have freaked out about cd4's a lot higher than mine, so I am nervous at this point. I have faith in my doctor though, whereas he has seen over 1200 patients with HIV and is among the leading researchers here in my city.

My glands on my neck seem to swell and return almost to normal on a daily basis and I have developed a small bump that is soar on the back of my neck on the right side. It is right above my hair line and my roommate has said it is not red or noticeable without pointing it out. Is this a gland? I also have a case of wringworms which I am treating topically. Is this a sign of lowering cd4's? Thanks in advance!

Response from Dr. Young

Thanks for your post.

It's very good that you've found an experienced HIV specialist doctor-- this is an important factor in patient's long-term success. I'd be in favor of starting therapy in the near future, especially if your counts should drop any further. Your lower viral load is in your favor and suggests (but by no means proves) that you'll have only limited CD4 declines in the short term. The fact that you're asymptomatic is very reassuring, though I'd point out that most HIV specialists wouldn't recommend starting sulfa prophylaxis for PCP until counts are below 200 (or 15%).

It also appears that you could have a small lymph node (gland) on your neck-- it is in a typical location for a periauricular (around the ear) node. The persistence of swollen nodes are not unusual for persons with untreated HIV, though I would advise you to have your doctor take a look, just to be sure that it's not anything more significant.

Ringworm and other skin infections tend to be more common among persons with lower CD4 counts, though these issues can certainly occur in persons with normal immune health too.

Good luck. Let us know how things turn out. BY

cd4 = 50---no meds
3 years now

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