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very low CD4 count
Jul 14, 2008

Dear Dr. Young, We live in the U.K and my partner was admitted to hospital last week with a pneumonia. He was tested for HIV and came back positive.The pneumonia has been diagnosed as PCP- he spent 3 days in hospital on IV septran and is now at home on orals. He will be on orals for 2 more weeks. He seems to be responding well to PCP treatment and his other various blood tests have been ok. However, i am so so worried because his CD count returned today and is only 6. He is due to go on HAART treatment at the very end of the month(he has to wait the 2 weeks for PCP treatment to complete). If he continues to get through the PCP treatment he will start on the ARV treatment.My question really is- what are the implications of him starting on ARV treatments with such a low CD4 count?...my impression is that it could take months(if he is lucky) to get up to (even)a 200 CD4 count?..surely he is at risk of O.I's right up till that point.?...i would really welcome any observations you may have on experiences starting treatment with such a low, low CD4 count.

Response from Dr. Young

Thanks for your post- I'm sorry to hear about your partner.

He indeed has a very low CD4 count and does need to start on ARV treatment in the very near future. A recent clinical study from our ACTG suggests strongly that patients with active AIDS complications actually do better when treatment is started as soon as possible, not delayed as we used to do here (and as your UK NHS doctors are planning). [Note that this study applies very specifically to patients with PCP, it's less clear how these data apply to patients with tuberculosis.]

With current treatments, patients with very low CD4 counts are equally as likely to achieve undetectable viral loads as those with higher counts. CD4s rises tend to be somewhat slower and lower than higher CD4 count patients, though at this time, there is little to do about this other than to continue ARV treatments. On average I'd expect at least a 100 cell rise in the first year (some get more, others less), the risk of OIs actually appears to decrease as counts rise past 100, but ideally above 200.

I would not despair though, provided that your partner gets through this initial storm and is able to adhere to- and tolerate ARVs, I think that his health will almost certainly improve.

Stay in touch and let us all know how things progress. Best of health to the two of you.

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