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stress and cd4 count
Feb 18, 2007

I was infected probably late 2005, found out accidentally I was poz through routine blood test. Otherwise healthy 50 something My labs: VL CD4 % 275 400/39 12/22/05 163 385/40 1/26/06 1610 553/37 4/10/06 1950 361/34 7/31/06 6940 399/39 8/25/06 5260 327/34 12/12/06 before the dips into the 300's I was told I probably wouldn't have to worry about meds for a few years. I figured that would give me time to adjust to eveything.

But the last cd4 is below the 350 threshold and I panicked. I am supposed to recheck in a couple of more weeks, had a genotype/resistance test done on 12/26/06 and am terrified of having a resistant strain. A new treatment naive patient in my clinic is resistant to everything even before meds. I have become so anxious and depressed over all this and have started on antidepressants and sleeping meds and they are hardly working. I've lost interest in everything, not even going to the gym anymore which I'm sure isnt' a good thing.

Please comment:

1.What do you think of my numbers? will I be starting meds soon?

2.It's said that stress lowers cd4 counts. Is it possible for me to "worry" myself into an even lower cd4 count on the next read if I can't "calm down" soon and need to start meds?

3.Also my lymphocyte count is 954 (1100-3500)cells/ul is normal. abs lymphs 0.96 (1.2 - 4.0 K/ul)is normal. Does this mean anything?

4. It would seem with so many people on treatment that the person I got hiv from probably was not undetectable and has passed a resistant strain. Is this more likely than not?

Response from Dr. Pierone

Hello, and thanks for posting. I will answer your questions last to first.

The risk of acquiring a drug-resistant strain of HIV varies quite a bit depending on location. In some cities the risk may be as high as 20 percent, but in general, the risk is well under 10 percent.

The total lymphocyte count in slightly depressed, but this is expected in the context of HIV infection.

There are some studies which suggest that high levels of stress lowers CD4+ lymphocyte counts. High levels of stress and the resultant anxiety and depression are associated with dramatic lowering of quality of life scores and need to be addressed proactively. Some useful strategies include counseling, medication, exercise, biofeedback, and education.

Your viral load is on the low side, but there is a upward trend. The CD4+ lymphocyte count suggests a downward trend and a count of 350 is often used as the threshold for initiating therapy. You have had only one reading below this level, so repeating the CD4 count seems like a prudent course while you address the stress and depression issues.

Let us know how things go and best of luck!



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