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HIV Treatment
Aug 31, 2006

I was diagnosed with HIV 12 months ago. A recent check up revealed that I have a CD4 count of 553 and a Viral count of 200,000. What does this mean and should I be on any medication. My doctor said I dont need medication at this time?

Response from Dr. Wohl

These are very important questions. Did you ask your doctor to explain the numbers? It is essential that your clinicians be able to not only be expert at treating your HIV but also in helping you understand what the virus does to the body.

This website and others can also help you learn about the basics. Check out:

http://www.thebody.com/treat/diagnostic_tests.html http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=124 http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=125

Basically, your CD4 cell count reflects the health of your immune system. CD4 cells (also called T-cells) play an important role in coordinating the body's response to certain types of infections. HIV eats T-cells for lunch. As the counts drop, the body becomes increasingly vulnerable to infections. Most people without HIV have a CD4 call count of 500-1000.

The viral load is the amount of HIV that can be found in a drop of your blood. The more virus, the quicker the CD4 cell count drops (think foxes and rabbits).

So, you want a high CD4 cell count and a low viral load.

You have a relatively high CD4 cell count but also have a high viral load. Chances are your CD4 cell count will drop steadily over time. Most clinicians in the US consider starting HIV therapy when the CD4 cell count gets close to 350, although this may be changing with some initiating treatment at higher numbers. One situation which doctors start HIV meds sooner is when the viral load is high. Therefore, many clinicians would wait until your CD4 cell count drops a bit more and then pounce, while some others would be more aggressive given your viral load and the high likelihood your CD4 will drop to 350 or so in the next 1-2 years.

An additional factor is how feel. If you have symptoms due to HIV, I would be eager to start at once. Likewise, if you were very motivated to start therapy and understood the issues, I would get out the prescription pad.

Talk to your doctor. Ask her/him what she/he would do if it were they who had your numbers. And, make sure your numbers are checked at least every 3 months.

DW



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