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Jun 8, 2009

I take 3tc efavirens and viddex for 4 years. i have udetectable viral load but my cd4 from 800 the last 3 years came now the last 1.5 year approx 350.i feel well,no symptoms never been ill with aids.When i started the medication my cd4 was approx 450.Are these medication still ok? do i have to change them to something new?

Response from Dr. McGowan

The main effect of the medications is to suppress the virus. That seems to be still active with yuor regimen. Dropping CD4 counts can be due to several factors unrelated to HIV itself. CD4 measurements are very dependant on which laboratory is being used. If you have moved or your doctor has changed to a new lab to run the CD4 count, that can make a difference. Also anything that causes inflammation, such as autoimmune diseases (lupus, rheumatoid arthritis, etc), chronic use of steroids (such as prednisone) for asthma or other diseases, or following a vaccination or acute illness, for example, can lower CD4 counts in the blood. Some medications, such as zidovudine, can suppress the bone marrow, which makes CD4 cells. Videx is unlikely to cause this (although responses were reduced when usual doses of videx were used in combination with tenofovir). Videx can cause mitochondrial toxicity which could cause many side effects, but not specifically CD4 drop. If you have any metabolic side effects (fat loss in the limbs or face, muscle/body aches, chronic fatigue, evidence of "fatty liver", or neuoropathy), then a switch to a new combo may be warranted.



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