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T cells crashing
May 30, 2006

Aloha Dr Young, I am a 53 yr old male, HIV-1 positive since 2/17/06. I was infected sometime within the past 2 years. On 2/17/06, T cells were 650, viral load 484,000. On 5/18/06 my T cells were down to 281, viral load just reported as >100,000 and ratio .19. I feel pretty good, I have an itchy chest rash but my Doc says that it's an allergic reaction to something topical. I am ready to start meds once the blood tests are repeated and the drug resistance assay gets back from the lab. Can you offer some explanations for the rapid T cell decline? My lifestyle is very healthy (No alcohol, no drugs, eat well, lots of exercise). Does the aggressive decline indicate that I should start on a certain treatment regimen? I was considering Sustiva and Truvada, if the resistance assay permits. Thank you.

Response from Dr. Young

Aloha-

Tahnks for your post.

You indeed have a pretty rapid decline in your CD4s- You've summarized things quite well, including the need to confirm your labs before reacting; nonetheless, your situation is not unusual (though fortunately not common). Your very high baseline viral load (about 500,000) is predictive of a greater rate of CD4 decline than average. Indeed, when one looks at populations of persons who are recently infected, a small percentage (less than 5%) will progress to an AIDS event within a couple of years.

Fortunately current medications can be very effective in patients like you--the tenofovir/FTC (Truvada) with efavirenz (Sustiva, Stocrin) regimen should be very effective and well tolerated (so long as you don't have evidence of transmitted non-nuke resistance). There are some doctors (I'd call myself in this camp) who might favor a boosted PI regimen (like lopinavir/ritonavir (Kaletra) or ritoanvir (Norvir) boosted fosamprenavir (Lexiva, Telzir) in patients with such high viral loads, though I'd be the first to admit that this is a belief system rather than a conclusion of large, well designed clinical trials.

I hope this helps, BY



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