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Time to start meds?
Apr 16, 2006

Hello Dr. Young,

My last set of labs show counts as follows: vl of 2,840 CD4's at 479 with a CD4% being 33%. My labs 4 months prior were vl of 1040 copies, CD4's at 663 with CD4% of 37%. My absolute Lymphocyes were 1815 on my prior lab workup and are now 1432.

I'm a 42 year old female who's been positive for 5 years now and have never been on meds. On my last visit, my Dr. said that it was quite a dramatic drop in my CD4 count and although my CD4 count is still considered good, it may be time to discuss treatment if the count takes another plunge on the next labs.

Another concern I have is the numbers for the MCH which was in the "out of range" column with the number being at 33.9 (last labs it was 32.8). My MCHC had a reading of 36.2 on my recent lab which also shows in the out of range and the prior labs had a number of 35.2.

I have done a little research on the MCHC and the MCH but I don't really understand what this means to me or my health being on the high ranges.

I was a heavy smoker, but just quit 2 months ago. As I get the feeling that the MCH and the MCHC might have something to do with the 2 pack plus cigarettes I was smoking per day.

Could you please tell me if you agree with the Dr. that if my CD4 number plunge again it may be time to begin meds (of course providing that the CD4% drops as well). In your opinion if the numbers drop again would you wait yet another 3 months (August) to check the next set of labs before getting on meds? My next visit will be in May. Also, can you explain to me what the MCH and the MCHC numbers represent, and is it cause for alarm that they too are in the high range?

From reading your forum, this sounds like a significant drop in the CD4%.

If you agree to begin meds, what type of regimen would you recommend for initial treatment? I am not diabetic and do not have any health issues.

Thanks so much!

Response from Dr. Young

Thanks for your post.

I'm not overly concerned about the changes in your CD4 count and percentage for now. The essential thing that you've not reported is whether you were ill at the time of either lab tests-- even minor things like a sinus infection or herpes outbreak can influence the CD4 levels.

You have a low viral load and to me, this predicts that any changes to your CD4s will happen slowly. Because of this, I'd be looking for a confirmation in trend, even before going to the discussion about a "plunge" in your counts or the need to start meds.

As for your other question, MCH stands for mean corpusule (red blood cell) hemoglobin-- both the MCH and MCHC are reflection of the amount of hemoglobin within the red blood cells. Many things can affect these parameters, and it's my understanding that recent smoking can do this.

I hope this helps, BY

Kaletra - once a day
Newly diagnosed with high viral load

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