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Should I start my treatment? 6 months ago numbers were ok
Dec 6, 2010

Hi docs, I really appreciate your work and time to answer all our questions. I have been diagnosed 1 year and a half ago. Numbers were ok every 3 or 6 months. CD4: 550, 525,687,510. Viral load: always between 10,000 and 25,000. But one month ago a did all the exams again and my CD4 were 421 and Viral load 172,000. I got bronchitis like almost two months ago (a lot of antibiotics and antinflamatories, it was a rough bronchitis..., now all ok but some coughing). My doctor told me to start the treatment but should i do the exams again because maybe the bronchitis and all the medicines affected my numbers??? is it normal a variation like this??? thank you very much docs... If i need to start it I will, I am very committed to stay healthy and do whatever I need to be ok.

Response from Dr. McGowan

Having an acute infection with fever, like a bronchitis can temporarily lower your CD4 count and boost up your viral load (for a couple of weeks). The change in viral load was a bit high, but it is possible.

There are other possibilities too. Sometimes HIV can change the way it enters CD4 cells. HIV can bind to 1 or both of 2 types of co-receptors (proteins on the surface of CD4 cells). A shift that enabled your virus to attach to both co-receptors could lead to a more permanent increase in viral load. This can happen naturally over time in about half of people with HIV. Another possibility is that you may have been re-infected with HIvif you had a partner with a strain that was more adapted to your immune system and could outgrow the original HIV strain in your body. Rare but possible.

ONe thing I would discuss with your doctor is your own thoughts about taking meds to kill HIV. In the past we would wait and wait and only treat if "we need to." Now we have a more proactive thought about treatment. We start at higher CD4 counts. Since your counts have been mostly in the mid-500s (we generally start at 500), it is near to starting. So starting now or waiting a few more months may not make much difference. We recommend earlier treatment now because we recognize that letting HIV grow unchecked for years can take a toll on the organs of the body long before AIDS would develop. Shutting down the virus early may help prevent this damage. I wouldn't view it as something negative.

Best, Joe



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