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Lowest ever, highest ever question
Apr 4, 2005


In following up on your answer below, when you say the 'lowest ever CD4...', do you mean after the primary or acute infection phase? My understanding is that during these initial stages, CD4 counts falls way down (VL's go way up) and then rebound and stabilizes for a period of time.

When I hear 'lowest ever' or 'highest ever VL', I'm not sure if it includes these initial phases.



I was diagnosed with HIV 9 yrs ago, was on meds for 5 yrs and was advised to take a break.It has been 2 yrs since now and my CD4 count is currently 480 with a viral load of 33,000.My overall health is pretty good, I don't smoke, drink and I exercise on a regular basis.I was distraught when my doctor mentioned to me that, from her expertise patients that has such a slow moving virus level don't do well when placed on meds again. My question to you is,"From your knowledge, could you be honest and let me know how many years should I look forward to after starting meds again?"

Thanks for your post.

I have to say that I disagree with your doctor's assessment. I have a number of patients who have discontinued medications after having a significant increase in CD4 counts (usually well above 750 absolute count). Some of these patients have been off treatment for a long time, others have had to resume because of declines in CD4s.

For this later group, I've not seen any significant issues with the resumption of treatment-- viral loads respond in the expected way.

Indeed, several observational studies as well as the large, ongoing CPCRA SMART study confirm our anecdotal experiences. In the later study, a strategy of discontinuous therapy appears (in a very preliminary analysis) to not incur additional risk of treatment failure.

Overall, the likelihood of having to resume treatment is based on what your lowest ever CD4 count was (CD4 nadir) and viral load- those persons with low nadir CD4s and higher viral loads tend to have a shorter period off medications than those who have higher CD4 nadirs or lower viral loads. Without knowing what your nadir CD4 count was, it's difficult to predict just how long you'll stay off medications, but if you've already been off two years, I'd suspect that you won't be resuming anytime in the near future. How many more years, I'd guess that it's at least another year; but this is a very crude guess.

The best way to act proactively in your healthcare is to rely not on predictions, but sequential laboratory tests.

I hope you find this helpful, BY

Response from Dr. Young

Dear Confused-

I'm sorry that this wasn't clear in the first post. Since the vast majority of persons with HIV never get CD4 counts or viral loads performed during acute infection (that is to say that most are diagnosed in the chronic phase), the general statement about nadir CD4 count or viral load refers to that during chronic, established infection.

Thanks for writing. BY

low cd4 high vl meds?
Should I be optimistic?

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