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Curious and concerned - should I continue meds?
Aug 8, 2006

I am a 29 year old heterosexual male and I was diagnosed HIV+ in May of 2005 at the age of 28. Initially, when I went in my VL was 26000 and CD4 count was 520. 3 months later, I went back in and my VL was 11000 and CD4 was 440. I then went in again 2 months later and my VL was 9000 and CD4 dropped to 275. I was then told I should start on the Sustiva and Truvada regimen. I immediately started. One month (yes one month) later, I went back in so my Doctor could see how my body was responding, and my VL was now undetectable and CD4 count was 570. I countinue to take the medications to this day as I have been on them since October 2005. I went in again in March of this year and viral load is still undetectable, but CD4 dropped to 440. Not sure how that happened. I do drink and smoke and as a matter my drinking increased after I was diagnosed. I guess maybe I am in denial, but I feel at this point I do not need to take the medications at this point. Would it be safe to say that I can stop at this point? Or would the medications become resistant? Also, based on the numbers provided, what are my chances are developing AIDS based on the above numbers?

Response from Dr. Pierone

CD4 lymphocyte counts sometimes drop despite viral suppression from HAART. When they do decline they typically rebound on subsequent testing. The higher the CD4 count, the more variability one sees in the measurements. So a decline from 570 to 440 is not unexpected in the face of successful therapy and represents the normal ebb and flow of CD4 lymphocyte counts in the bloodstream.

It is not definitively known whether you need to be on medications at this point. You did have one test below the widely accepted 350 CD4 lymphocyte threshold, but it is possible that this one test was not fully reflective of your immune status. Focusing on CD4 percentage can often be helpful to get a better sense of immune function, since this measurement tends to fluctuate less than the absolute CD4 lymphocyte count. Since you are not having side effects, there is no strong reason to stop therapy. But if after talking to your doctor, you decide to stop medications there is a low risk of developing drug resistance related to a one time stop of antiretroviral medications. Sustiva has a longer persistence in the body than Truvada, so many clinicians would recommend stopping the Sustiva a week or two before the Truvada.

The chance of developing AIDS, either an opportunistic infection, or a CD4 count below 200 is very low if antiretroviral therapy is taken to prevent this from occurring. In the absence of therapy one would expect the CD4 counts to drop at variable rates and eventually make it the AIDS range. Also, smokers have a faster rate of CD4 count decline, so quitting smoking would be a terrific positive change.

Thanks for posting and good luck!



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