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3 years now
Jan 16, 2005

Dear Dr,Young, I started asking you questions three years ago when i was diagnosed with hiv.my vl at the time of diagnosis was 704 thousand and cd4's where 240.I just hit my three year mark on sustiva and combivir my latest labs where vl 200 and cd4's 1350.although i am truly amazed with my cd4 count I am beggining to wonder if i am ever going to be undetectable.my doc says not to worry about it because we dont really know what the diffrence is between my 200 and the traditional 50> to undetectable really is.my question is this.am i ever going to reach undectectable and why have i had and maintained such a high increase in cd4's over the years when other peoples cd4's only increase by a couple hundred.not that i'm complaining.just curious? thanks for your answer in advance.

Response from Dr. Young

Thanks for your post.

I'm very heartened to hear that your counts have improved som uch and that you're doing well.

Your situation is not unique-- indeed, I just had this conversation with a colleague from Sacramento. There are a minority of patients (particularly those who start with very high viral loads, like you) who never quite seem to get to the magical undetectable level of below 50. Despite this, their CD4 counts continue to improve and the viral load (this is important) does not seem to rise with each subsequent measurement.

You are correct in that there really isn't all that much difference between a viral load of 200 and say, 49, especially if one starts at 700,000. The thing that worries us all is the possibility that such low viral loads set the stage for the emergence of drug resistance. This clearly happens for some unfortunate people. The fact that your viral load doesn't increase suggests that if such resistance has emerged, that there is sufficient "residual" potentcy from the treatment that you're taking to prevent any further problems.

As to the last part of your question-- why some increase their CD4s a lot and others only a little, is not entirely clear. There are some suggestions that there are both viral- and host- (human) factors that may govern this. You're response is clearly on the robust side- most persons can expect a CD4 cell rise of about 100-200 cells per year.

I hope this addresses some of your concerns. Have a happy and healthy new year; thanks for reading. BY



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