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TMC278, CD4 vs. %
Nov 4, 2007

Drs,

I was recently diagnosed HIV positive. My last two HIV tests were six months ago and over one year ago, respectively, and both were negative so I think it is safe to assume that I was recently infected.

My first blood tests were shocking to me CD4 277, 26.6%. The doctor repeated the test and one month later my results were CD4 255, 25.4%. I am very concerned by my results because I was so recently infected. My doctor told me that while my CD4 is low, the percentage is high, which is a more accurate figure to go by. I was wondering if you agree.

Also, when discussing treatment options, I have opted to participate in a study because I am having some insurance issues. Regardless, the earliest I could start medication is two months do you think its safe to wait that long? I dont want to take any unnecessary risks with my health.

The study I want to participate in is for TMC278, Im also wondering what you think about choosing that drug as a first option.

So my question, is three parts: 1. is the % a better indicator than the actual CD4 count?; 2. Given my CD4 and percentage, do you think I will be ok waiting 2 months?; and 3. do you recommend taking TMC278, given that I am drug nave?

I really appreciate your time. Thank you.

Response from Dr. Wohl

1. The CD4% is helpful and can help put absolute CD4 numbers into perspective. I agree that your high CD4% is a good thing. I suspect your body is still recovering from your recent infection with HIV. It is likely that your CD4 count will rise.

2. The CD4% being high also makes me feel more comfortable with your waiting a few weeks to start meds. In fact, it may give some time for those CD4 cells to rebound.

3. This is a good clinical trial and if it is the one I think it is you have a chance of getting Sustiva or TMC278. A clinical trial is done because there is a gap in understanding. We do not know if TMC278 will be just as effective and safe as Sustiva (that's why the study is being done). But, the available early data in people suggests that TMC278 will work well. Given your situation, I think the clinical trial makes lots of sense and TMC278 is an exciting drug that is still under development. Since you were recently infected, it is important that a genotype resistance test be done to make sure you did not acquire a nasty drug resistant virus.

DW



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