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Re: Drop in CD4

Feb 4, 2009

Hi Doc BY,

I havent got my viral load yet coz here in the Philippines they give priority to the patients with very low CD4 count before they run the viral load test.

as for the description of my last test: Description Count Cell CD3 800 CD4 99 CD8 644 CD16+56 117 CD20 127 CD19 135

Based on comments: All parameters have decreased relative to previous atudy but B cell counts are stil within normal reference range.

I was given a new prophylaxis by my doctor its called Klaricid (i am alergic to Bactrim) Is Klaricid a good choice and any interaction with my ARV?(efavirenz, lamivudine and tenofovir)Or is it really necessary to take prophylaxis at this point?

Thank you once again.

Response from Dr. Young

Hello and thanks for the follow up note.

If your counts are all down, this would be consistent with a general suppression of your white blood cells, and not necessarily a specific decrease in only your CD4s. Hence, I wouldn't worry much about this.

Klaricid is clarithromycin- a medication used to prevent Mycobacterium avium (MAC) infection- we'd only use it in patients whose CD4 counts are below 50 (rather than your ~100). Clari doesn't have any significant interactions with your HIV medications.

Bactrim (Trimethoprim/sulfa) is used no to prevent MAC, but Pneumocystic pneumonia (PCP). PCP prophylaxis should be used until your CD4 count is repeatedly above 200 (and 15%). There are alternatives to Bactrim, such as Dapsone or atovaquone. I'd ask your doctor for clarification.

Be well, BY

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