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Which is more significant. Viral load vs. T-cell counts?
Mar 6, 2006

I am a 39 year old female and I found out my status about 10 months ago and I was a early detector. My initial viral load was 1,026 copies with t-cell count of 456. My recent labwork showed my viral load went down to 740 copies with t-cell count of 366. I am not on any therapy nor have not been on any therapy. My specialist tells me I shouldn't be too concerned with my t-cell counts lowering and that my viral load is the significant and that I'm doing outstanding! Don't get me wrong, I am happy and feel very blessed that the numbers are where they are. But, if my t-cell count continues to lower, when or should I be concerned? Thank you!

Response from Dr. Wohl

Both CD4 and viral load are important but they provide very different information.

The CD4 cell count tell us about your immune system at the time the blood is drawn. A low CD4 cell count indicates a risk for infections. From day to day, our CD4 cell counts can change (just like our blood pressure and temperature). So there is some variability in CD4 cell counts. When there has been an unexpected change in CD4 cell counts, doctors will look at the CD4 percent - a number that is more stable than the absolute count. I would hesitate to say you experienced a real drop in your CD4 unless the CD4 percent also declined and it is confirmed on a repeat test.

The viral load generally stays fairly stable during the course of HIV. This test tells you about how likely it is your CD4 cells will drop. A high viral load predicts a more rapid decline in teh CD4 and a lower load, a slowe drop. Like the CD4 count, there is wiggle room in the test result. The same tube of blood can be tested two times and come out with different viral loads. Generally this difference will be within a factor of three. So a 700 viral load is not that different from a 1400 viral load.

If you were recently infected, your CD4 may stay down for a few months then pop up. But, if six or more months after infection your CD4 cell count is 350 or so and stays there, I would consider starting HIV therapy.

DW



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