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Decrease CD4 count and increase %CD4
Jun 24, 2009

Dear Doctor, I was tested HIV+ on 17 Dec 2008 (with very throat pain)with CD4 Count 154, %CD4 8.8 and Viral Load 49,200 (by COBAS Ampliprep, log equivalence 4.69 Log. I started ARV (ie 3TC, tenofovir & Efavirenz)on 16 Jan 2009(after healed of throat pain). My second test result was CD4 count 358 and %CD4 12.4 on 3rd March 2009. My third test result on 30 May 2009 was CD4 count 330, %CD4 13.6 and viral load less than 40(ie undectectable), Log equivalence less than 1.60 Log. i am very worry of my third test result as the CD4 count was only 330 (ie decreasing). I am 50 years old. My doctor said that it was still a good result as the the %CD4 was increasing. My throat is still "dry feeling" at infected area sometimes even though it is healed(no pain). Is it possible for me to increase CD4 count during the next test(appointment on 18 Sept 2009)? I did not miss a single dose. Do I have to change the ARV meds? I stopped taking bactrim on 30 May 2009. Is the throat pain will come back again in the near future. Please advise me.

Response from Dr. McGowan

I am glad to see that you have started meds and are tolerating them well.

You are having an excellent response to your treatment. Your viral load has become fully suppressed. Your CD4 counts have more than doubled in a short time.

There is a relationship between the CD4 and the CD4%. T cells can be divided into 2 main types: CD4s and CD8s. Normally their are more CD4s than CD8s, but with HIV, the CD4 number drops faster than the CD8 and the balance is thrown off. Think of an apple pie. The size of the apple pie (large or small) represents the total T cells in the blood. Think of their being a slice in the pie. Normally the bigger piece is the CD4 count, but with HIV the CD4 slice gets smaller and smaller. In your case it was down to 8.8% of the pie. Now it is up to 12.4 and then 13.6% of the pie. It is getting back to normal.

The total CD4 count is derived from the total T cell count and the CD4%. The number of T cells in the blood varies from day to day and morning to night as the T cells move in and out of the tissues of the body to fight infections. Think of the pie again. If you have 2 pies, one large and one small, each with a slice that is one quarter (25%) of the pie. Even tough one slice is bigger than the other, they both represent 25% of the pie. HIV only determnines the size of the slice (25% or 50%), not the size of the pie. So even though your total CD4 count went down (the pie got smaller because some of the T cells moved in or out of the blood), the slice got bigger...which means the effect of HIV on your CD4 balance was less.

I agree with your doctor , things are going fine. Keep up the good work and try not to miss any doses, just as you have been doing.

Best, Joe



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