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severe drop down in cd4 and increases viral load: should I start treatment soon?
Feb 3, 2011

First let me take the time to say thank you for addressing and answering all our questions.this forum is really an unvalueable source of info. I am worrying because my viral load increased a lot in the last set of exams and my cd4 relative and absolute both drop down too. here are my set of exams over the last 3 years: I was diagnosed positive on end december 2007(and tested negative on march 2007). february 2008 vl5000, cd4 728 ;october 2008 vl7131, cd4 817, %cd4/cd3 0.73; march2009 vl2611, cd4 707, %cd4/cd3 0.72. august2009 vl2264 cd4584 %cd4 0.76;april 2010 vl8379 cd4 574 %cd4 0.49; december 2010 vl 25614, cd4 323 %cd4 0.33 Do you think it is better to repeat the tests or starting treatment right now? and also is this drop of cd4 common over a three year period? thanks for your time regards

Response from Dr. McGowan

Thanks for the compliments.

Yes, I think these numbers would indicate a need to start treatment. The trend has been down and now the levels are well into the range that treatment would be advocated, why wait? Even if the repeat was slightly up the trend is clear, so a couple of extra months off treatment is all you would buy. The viral load has not really changed by much (all numbers have been in the 15-20,000 range which is not a significant variation). I would discuss with your doctor being sure that there is no new infection or other condition (such as tuberculosis, fungal infections or lymphoma) which may also be causing the drop in CD4. These tests could be done while you are getting started on treatment. There are many good and more simple treatments available now, discuss with your health care provider which ones may be right for you based on the resistance pattern of your virus. This is the opportunity to turn the trend around instead of waiting and doing nothing.

Best, Joe



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