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low CD4 and second regimen
Mar 8, 2010

hello Dr. Joe, I have asked you twice or so regarding my sister's medication. From 2006 to the first half of 2009 she was on combivir, stocrin and bactrium. She started with CD4 of 10 and percentage of 1. The CD4 then rose to 90 and percentage of 10. But it couldn't rise above that. Her viral load was 1,430. I am not sure if the viral load count is the same everywhere. Then her doctor changed her medication to abacavir, lopinavir, didanosine and bactrium. However, the CD4 and percentage did not change. But in her latest lab result the viral load was less than 400. And the doctor said that if the viral load is less than 400 that is the target he wants to achieve and hence she should not worry about her CD4. Dear Dr. Joe, what do you make of this? Is the medication still potent? If not, what option exists from now on? The other thing is on your website you often say the viral load should be less than 50 for it to be said undetectable. Are there other measurements too considering what my sister's doctor has said? Many thanks

Response from Dr. McGowan

Thanks for your question, I am glad your sister has been doing well.

The best response to treatment is to have a viral load as low as can be measured. The test used by your doctor can see as low as 400 copies. There are more sensitive tests that can detect down to 50 or even 20 copies. These may not be available where you live. The test that is most sensitive should be used. If you cannot get access to the more sensitive tests than the longer the viral load stays below 400 the better. If someone gets repeated tests for months and years and is always less than 400, the odds will be that they are also less than 50. That is what we found when these more sensitive tests first became available. The viral load dosen't usually stay between 50 and 400 for very long, it either continues to drop to below 50 or will rebound up and get back above 400 after a short time. So, if 400 is the lowest you can measure, just keep going for follow-ups, don't miss any doses and be sure the level is always below 400. Best, Joe



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