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Treatment In The Future
Nov 27, 2005

Hi Doctors,

I have been diagnosed HIV+ for a year now, and I live in Thailand.

I'm slowly coming to terms with things.

I have 2 questions.

I have had three sets of labs done, and my CD4 has dropped from 767 down to 580 in the space of 11 months. However my CD4% has remained the same at 38%. My specialist says "not to worry" as my CD4% has stayed the same, and if I had the last blood test a day later my CD4 may have shown 700 instead of 580. Can you explain what he means, and should I worry about the CD4 drop as my CD4% has stayed stable at 38%. I don't understand how these 2 figures correlate.

Secondly, my specialist says that all being well, it should be 3 to 4 years before I need medication. Does this sound right to you? Could it be longer? What do you think the future will hold for someone like me who (potentially and hopefully) will start meds in 3-4 years time? I am hoping to have a long and happy life (I'm only 33), and will it be as simple as "one pill a day" in a few years time? What about drug resistance? Is this going to be better in the future? I don't understand why people still die of AIDS if medication is at such a stage now where life expectancy can be classified as "normal of near normal". My specialist, and a lot of replies on your forum say that life expectancy is "normal or near normal" with the medications we have these days. What's the future for meds and for me?! I'm confused! Please help!

Response from Dr. Wohl

There are two measures of CD4 cells that are used clinically. The first is the more familiar absolute CD4 cell count. In this test the number of CD4 cells in a cubic millimeter of blood is counted. The second test is the CD4 percent. Here the proportion of white blood cells that are CD4 cells are calculated.

The way I describe the relationship between these tests to patients is to think of the white blood cell count as a pizza pie and the CD4 cells as a slice of the pie. With a large pizza pie (i.e. lots of white blood cells) the CD4 cell slice is big (i.e. more absolute CD4 cells). But, with a medium sized pie (less white blood cells that day) the slice is smaller (less absolute CD4 cells) - even though it is still a whole slice of pizza. As long as the percent (how many slices of the pie your CD4 cells make up) stays stable, then generally all is well despite normal fluctuations in the number of white blood cells on a given day.

As far as prognosis, the missing piece is your viral load. The viral load predicts how fast your CD4 cells will drop. The higher the load, the steeper the decline and just to opposite with a low viral load. But, even with a high viral load, medications work and work well.

Why do people in places where HIV medications are available still die? Data suggest several trends. Some die from other diseases such as hepatitis C virus. Others, present too late, often with an opportunistic condition. In our clinic, several recent deaths were among patients who for various reasons such as continued substance abuse and mental illness could not adhere to their medications.

I suspect with your determination, you will do great for years and years to come. Keep asking questions.

DW



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