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needs of medicine soon?
Aug 31, 2009

first of all thx u for the commitment to this forum: you really help all of us. these are my 4 sets of exams numbers over the last 2 years february 2008 vl5000 cd4 728 (when i was diagnosed); september 2008 vl 7131 cd4 817; march2009 vl2600 cd4 707. august2009 vl 2254 cd4 584 %cd4 always stable at 32% in all the four sets of exams. I am worried because a loss of more than 230 cd4 in two year is not the average (expecially with my level of vl, and btw is it really in the low range?) given this results should i start med? or anyway do you forecast meds in my following future? can you give me an idea, given your statistics, on how hiv is progressing in my body? the second question: my vl is decreasing of a 3 fold since the last test: does this have any meaning? if so why i lost more than 200 cd4? another doubts is about the cd4%: if specialists say is a more stable number than abs cd4 and not to worry unless you are loosing 3 or more % points, why cdc guidelines use absolute value of cd4 to start or not start meds? now coming back to my case in brief is this big loss of cd4 due to hiv (even if the % is constant at 32%) and should i start meds soon? really thanks for your help

Response from Dr. McGowan

Thank you for your questions. They are very thoughtful. It is good to have trends to look at since the numbers can fluctuate from test to test. To addess some of your questions:

Yes, your viral loads are in the low range, they tend to be around 10,000 or less and you are not on any meds to account for it.

Also, your viral loads are all within 3 fold of each other. For example, if your "real" viral load were around 5-6,000 all your values fall within 3 fold of that amount. So things have been pretty stable.

The changes in your CD4 count may just reflect normal fluctuations as well. That is where the CD4% helps since usually, if the CD4 changes were driven by HIV, the % would also be decreasing since HIV drops the CD4 count fatser than the CD8. This decreases the CD4 share of the overall T cell count (this is what the % is measuring). When we measure the CD4 count, it is only the CD4 cells in the blood that we measure, not the cells in the tissues. As CD4 cells move into or out of the tissues to fight infection or inflammation there number in the blood may go up and down.

The decision to start meds can be based in part on the CD4 count, but there are other reasons to start. As long as you have access to newer meds that are less likley to cause metabolic side effects then you may elect to start treatment sooner. You must be committed to take tratment without missing doses. But, there is nothing in these labs so far that would make it an emergency to start now.

Best, Joe



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