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Dropping CD4
Jul 28, 2008

I have been on Atripla and Bactrim since 11/07.My viral load is going down ,but my CD4 count os also going down.It went from 167 in Feb.08 to 140 in May 08.Everything that I have read on HIV/Aids indicates that this has turned to Aids and no longer just HIV,is this true?And if in fact it is Aids now,when my CD4 count goes back up[trying to be positive about the matter]will it be considered HIV again or is it still considered Aids even with good numbers?Please be honest in your answer.I cannot seem to get a straight answer on the matter.

Response from Dr. DeJesus

Thanks for the question. The reason why you have not received a straight answer is because this topic remains somewhat controversial. The current definition for AIDS includes any HIV person with either an opportunistic infection or a CD4 count <200 cells. The decision to include people with CD4 count <200 cells was made somewhat arbitrarily many years ago, and based on the fact that at that CD4 level the chances for someone to develop an opportunistic infection was significantly higher. In theory, and for statistical reasons, any person that has met the definition for AIDS remains counted in that category even if the CD4 count improves; but in reality, they should not.

With HIV treatment as you have already seen, the HIV viral load will decrease (and it should be < 400 copies by week 24, and < 50 copies by 48 weeks). With that viral response to treatment, CD4 count increases, a term called immune-reconstitution. By now we know that once the viral load becomes undetectable and the CD4 count increases above 200 cells, your chances to develop an opportunistic infection are extremely low. Some patients are even able to bring their CD4 count back up to normal levels, and they should not longer be considered for practical purposes to have AIDS any longer.

My recommendation, don't get too hook up on those definitions...they mean very little at this point. Concentrate on taking your meds, maintaining a viral load undetectable, and the CD4 count will likely increase so you should not longer be considered to have AIDS then.


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