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RESULTS GOOD OR NOT SO GOOD
Aug 2, 2006

I am extremely confused about my results. Diagnosed in Late Feb. - CD4 226 VL >100,000. Given 3 treatment options (how i hate patient choice, we even have it in the UK on the NHS now) I opted for Truvada and Sustiva, as they seemed to have less side effects, were newer drugs and did not include AZT. First month results CD4 330 VL 1600, second month CD4 300 VL 300, last month CD4 240 VL 200. I do not understand why my CD4 is going down. My last blood test was done at 8.00am and just after a flu, would that have effected the result and to what extent. Also should after 4 months of treatment my VL not be undetectable i.e.<50 like other peoples I read about. Do you think I made the right treatment choice in the beginning or is it just me being paranoid and its still early days. Btw I have 100% adherant, 2 pills at night it aint that hard after all. Thank you guys for your time and your invaluable service. Jas.

Response from Dr. Wohl

Dear Jas,

Your CD4 cell count has, on average, increased. Two of your last three counts were greated than the one you started with. Why is it not even better? Several possible reasons: Your CD4 cell count right before you started therapy was actually higher than average for you. CD4 cell counts fluctuate and it could be the day it was checked prior to treatment, it was a peak. Alternatively, your last CD4 cell count of 240 may be low due to the same fluctuations, lab variability, or because of your flu. One thing to look at is the CD4 percent (the proportion of white blood cells that are CD4). If the CD4 percent is increasing, I would not worry much about the absolute CD4 cell count.

Your viral load is flirting with undetectable but has not yet crossed the magic line. You started with a really high viral load, so it will take longer. Did you have a resistance test performed prior to therapy? While it is unlikely, viral resistance you acquired when you were infected could lead to less robust response to therapy if a drug is used that your virus is resistant to. I would see if your doc would be willing to check a genotype test. Although your viral load is low, these tests can sometimes give results even when only 300 copies of virus are present. If no resistance test can be ordered or these is too little virus to get a result, I would not fret and would continue to monitor your counts as you are doing.

I think you made a good choice as far as therapy. Let's see what happens with your CD4 percent, next viral loads and any resistance data you are able to get.

DW



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