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Decreasing white cell count

May 27, 2009

I have been hiv+ for 5 years and on Sustiva and Truvada for 17 months. All my lab results are good except my white cell count which has been steadily decreasing throughout the 5 year period. My doctor says the decline post HAART is probably due to FTC component in Truvada causing a mild suppression in the bone marrow. Do you agree? Should I replace the FTC with Abacavir. My last WCC was 3.36. Thanks

Response from Dr. Young

Hello and thanks for your post.

It's not clear exactly what is the cause of your declining WBC count. While it's reasonable to try substituting one drug for another, I probably wouldn't substitute abacavir for FTC. This would put you on a rather unconventional regimen of tenofovir/abacavir+efavirenz. There are circumstantial data that would suggest that this combo might not be as effective as desired.

At the least, I'd suggest replacing the FTC part with 3TC, or the tenofovir with abacavir (provided that your HLA genetic test was negative). Indeed, some case studies have suggested that tenofovir can be associated with rare cases of WBC or CD4 decline, despite having undetectable viral loads. Last, a switch from efavirenz (Sustiva) to a boosted protease inhibitor or nevirapine would determine if that was responsible for the decreased WBC.

I hope this is helpful,


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