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Constant falling Viral Load and CD4 count
Aug 7, 2006

Dear Sir, I am HIV+ and wants to know certain facts regarding the CD4 and Viral Load. To start with, I am from India, when I was tested + for HIV last year in october my CD4 and Viral Load as follows: 430 70,000 three months later it was 580 1,80,000 three months later it was 315 54,000 three months later now it is 160 480 The way CD4 and Viral Load are changing is not convincing. please anybody in the Forum guide me to know the actual reasons and suggest me that whether I should go for the ART. I mean its crucial. since I am taking the herbal medicines and reply from my Homeopathy doctor is not very satisfactory. I want to know: 1) Why the CD4 is decreasing? 2) Why the Viral Load is also decreasing? 3) In most of the cases the relationship between the CD4 and Viral Load is inverse. Please help me to clarify the facts.

Response from Dr. Young

Thank you for your post.

Your viral load tests are inconsistent-- the first three would be considered within the normal variability of the test; within a 5 fold range. Hence, excluding your last viral load test, you could say that there was no significant difference. The last value is more difficult to interpret-- either it's an effect of your herbal medicines (I tend to discount this possibility, but possible), or it's a laboratory error (also possible).

Your decline in CD4 count decline is more readily explained; you have HIV. HIV can and does cause CD4 declines, even among persons with average to low viral loads. People get confused on this point; just because one has a low viral load doesn't mean that you're protected from CD4 loss or AIDS. Indeed, I have a few patients with undetectable or very low viral loads (off antiretroviral medicines) who progress to have CD4s less than 200. Your last CD4 also seems to have a larger drop that I'd expect-- suggesting lab error; but not a value that I'd be comfortable with.

If I were your doctor, I'd repeat the tests in the next few weeks to ascertain if the trend is confirmed. If the CD4 count is again below 200, then this would be considered confirmation of an AIDS level and the need to start antiretrovirals.

I hope this helps. BY

IRIS - immune reconstitution inflammatory syndrome
Abnormal Lymph Node

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