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CD4 drop, do I need to shift ARV medical?

Apr 30, 2010

Dear Doctor, i am tested HIV+ on 18 Dec 08, CD4=154, CD4%=8.8, VL49000, i started taking 3TC, tenofovir and Efavirenz from 17 Jan 09. My test results were CD4=358, CD4%=12.4, VL less than 40 on 3 March 09, CD4=330, CD4%=13.6, VL less than 40 on 30 May 09, CD4=372, CD4%=13.7, VL less than 40 on 15 Sept 09, CD4=300, CD4%=14.7, VL less than 40 on 14 Nov 09 and CD4=289, CD4%=14.5, VL=58(detectable) on 25 Feb 2010. I found that my CD4 continue dropped from 372 to 300 and then to 289. My doctor still asked me to take the same medical. She told me that it is not resistant and not necessary to swift the medical so soon. Before ARV on Dec 2008, I have had sore throat (very pain) at left tonsillar ulcer. I was treated well (after biosy) by taking valtrex, avelox and prednisolne as from 9 Jan to 17 Jan 09. The infection area always still give me not smooth feeling. Do you think that the pain of sore throat affect area will come back again if my CD4 continue drops further? Do I have to change the ARV medical? I am very worry. Please advise me.

Response from Dr. McGowan

Thank you for your question.

The general trend of your CD4 counts has been very good. This is seen in the CD4 % which had increased from 8.8 to 14.5. The numbers can vary from test to test, but the trends have been very good. The most recent number had a slightly higher viral load. If you had inflammation (fever, a bad cold a recent vaccination) when that last test was taken it could account for the drop in CD4 and the slight increase in viral load. This very low level of virus would not indicate breakthrough or resistance as long as the repeat a few weeks later is back to undtectable (< 40) again. Rather than waiting 3 months to repeat, I would suggest a follow-up after 4-6 weeks to be sure that the counts are stable and the viral load undetectable.

Best, Joe

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