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General Question
Jan 31, 2011

Do you think there is a difference between someone who is diagnosed with HIV shortly after the acute phase of infection (say around 6 months) but whose viral load never really receded and the CD4 plummeted and never recovered and someone who got to the same point numbers-wise after many years without medication? Someone very close to me was diagnosed within 6 months of infection but his numbers were CD4 156 and VL 650,000. After 4 weeks of medication his viral load was undetectable and his CD4 was 329 at 31%. It seems counterintuitive to say he started medications "late" since he had only been infected for about 6 months (this is based on his last HIV test).

Response from Dr. McGowan

You present avery good question. There is a great deal of controversy about what is "early" and "late". We know that the virus is already widely established within the first few weeks of infection....even before the HIV test may be positive. There are no studies to addtess your question directly, although experience does show that recovery of CD4 may be quicker if the counts are not low for long. Also younger people recover more quickly and completely. CD4's can also be lowered if there is an active opportunistic infection. Treating the OI can also boost the CD4 count plus the gain from suppressing the virus.

JOe



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