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Tb with CD4 over 700
May 7, 2008

I had a positive result of sputum to TB, CT of chest shows nodules like rice size cavities throughout both lung fields. My CD4 is 790 and VL below 70. What gives? Could my percentage have changed to allow this? Am I infectious?

Response from Dr. Young

Thanks for your post.

If you have TB in your sputum (as determined by special stains) and you're not currently on TB treatment, then you are infectious. Your immediate family and friends (and their doctors) should be notified as soon as possible.

From your undetectable viral load, it would appear that you're on successful HIV treatments; nevertheless, you should be getting ready to begin treatment (usually 3-5 drugs) for tuberculosis. TB is highly contagious and more severe among persons with lower CD4 counts. Your normal CD4 did not protect you (nor others) from getting TB and speaks to the need to screen HIV+ persons for previous exposure to TB.

Here in the US, we typically start with 4 or more drugs and adjust the treatment based on microbiology susceptibility testing. Treatment for HIV-TB coinfection is for many months.

Best of health to you, BY

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