Hi Doctor, my brother started haart 2 yrs ago (kivexa + sustiva). He became undetectable within 6 months, even after a severe seroconversion (pneumonia, meningitis); however, so far, his cd4 count has not grown as much as I hoped, after an initial increase (from 220 to 500). His cd4 count remains constantly around 550, the cd4/cd8 % around 32. Is this normal? Is his haart combination effective enough or should he switch to a more potent one? Apart from that, he looks fine, never misses a pill, never had problems, play sports and think positive.

Thank you again for your precious job. From time to time I go back to the responses you have already given to me, to find some relief...

I'm sorry... I'm always a scared sister!

best S.

I would not be too concerned about your brother's stable CD4 cell count. For one thing, it is fairly high at 500 and 32%. Second, his viral load is undetectable, so the regimen is indeed potent. Lastly, another combination is unlikely to change the situation.

I doubt any of the HIV medications he is taking is suppressing his CD4 cell count. Other medications, such as Bactrim or Septra, can occassionally hold back CD4 cell gains. I would leave this treatment alone and keep tracking the numbers as you are doing. I suspect he will do fine.

DW