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Scared to Get 2nd Set of Labs
Mar 19, 2005

Hi Doctors,

I tested positive in January this year, (infection time unknown), and my initial labs showed a CD4 count of 761 and CD4% of 43%, and VL of 111,000.

My specialist has reassured me that I should not need to be on medications for quite some time, and that my high VL could have well been due to a slight cold I had at the time of the labs.

It is now time for another (my 2nd ever) set of labs and I'm very scared. What chances that these set of labs will show a CD4 count of, say, something like 200-250? i.e. A massive drop.

I was quite pleased with the initial count in the high 700's, which, the specialist said, meant my immune system was in good condition. But what if these labs come back showing a massive drop? To me, its more scary getting the second set done than the first. I have read that the average drop in a year is 50-100, but is it possible for the CD4 count to drop 3,4, or 500 in the space of three months? I'm so confused (and terrified) of getting the second set of labs done.

To be "med-free" for at least 5 years would be a dream. Based on the initial numbers, do you think this is possible?

Finally, I live away from my home country. As I can get the labs done much cheaper at home, I plan to do this when I return next month. Is it ok to get a CD4 and VL count done in different countries? Would the results be the same wherever I get the tests done?

Thanks for all the great work you do on this site.

Response from Dr. Young

Thanks for your post.

Apprehension about the course of your HIV disease is common-- however, having laboratory data that pertains to you (rather than a projection from a mythical "average" person) is the way to best understand how your body will respond to the virus.

It's not likely at all that you'll see your CD4 count drop from 700 to 500 (with a corresponding CD4% drop) in a short period of time. There are a minority of persons who do have a more rapid drop, but even in this circumstance, it'll be important to follow trends much longer than just 3 months to be sure.

So, if I were your doctor, I would try to mitigate your confusion and terror about getting a second set of labs with the value that such actual lab data can provide. (And yes, you can get the testing done in different places; there might be minor differences from country to country, but I don't usually expect that they'll be dramatically different.)

Staying medication-free for a long time is a good goal (and need not be a dream)-- I see that this is entirely possible, but I certainly would not recommend that you use this projection to ascertain when you'd start. The best way to determine when you might need to start is by careful and repeated laboratory monitoring; I recommend getting lab tests, whenever possible, every 3-4 months.

Good luck, I hope this helps with your understanding of how to monitor your health. BY


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