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Initial Steep CD4 Decline
Aug 16, 2008

My girlfriend was diagnosed as positive a little over three years ago. About 6 months prior to that, she had been tested at a clinic and the result was negative. However, we live in Cambodia, it was a Chinese-run clinic that we knew relatively nothing about, and the results were back within 30 minutes - what seemed to be a very short time frame in Cambodia at the time.

So when she was diagnosed as positive 6 months later, we simply assumed that the Chinese clinic had either not actually sampled her blood or she was a false-nagative. Either way, I was quite angry at the danger to my girlfriend and myself (and possible others) from this incorrect diagnosis.

Anyway, her initial CD4 was around 250, so we got her started on treatment right away. Soon after, her VL was undetectable and her CD4 level had risen to the 700 range - where it has remained to this day (after a one-time slip to around 500).

However, I am just now learning of the steep CD4 decline when one is initially infected and am wondering if maybe we acted hastily by initating treatment at the time that we did. My concern is that she is being subjected to the toxicity of her medications at a time when she need not be.

At the time prior to diagnosis, she was contracting various illnesses what seemed like on a monthly basis.

Also at the time, she was 19 years old, and has been as low as 36 kilograms, while now around 40.

Are there any conclusions that you can draw from the information that I have provided?

Thank you for all of your help.

Response from Dr. Young

Thanks for your post.

I wouldn't view starting treatment with a CD4 count of 250 a hasty decision at all. This value was 100 cells below the level that treatment guidelines here in the US and in western Europe recommend for starting.

The major conclusion that I draw from your notes is that your girlfriend has had a really terrific initial response to treatment. This is highly predictive of her long term prognosis, provided that she is able to continue adherence and medications continue to be available in your region.

Best of health to both of you, BY

theraphy with only 2 drugs?
Must Atripla be kept in the bottle with the dessicant?

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