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CD4 stil declining after 1st month of treatment
Jul 28, 2011

Hi,

My boyfriend is positive, I'm negative. He got diagnosed 1.5 years ago with OK numbers (can't reacll exactly), but his June checkup showed scary results: CD4 307, C4% 19, so they started treatment 06.22.2011.

They put him on Reyataz and 3 other meds, but he turned really yellow after the first week so they switched to Prezista.

His current mix is: Prezista 800mg Norvir 100mg Viread 245mg Epivir 300mg

He has been taking all the meds properly, no dosage missed.

The problem is he just got his one month followup results today and the were anything but good: CD4 255, CD4% 9. (No virus level check was done).

The doctor told him to keep taking the meds and go back next month and he will "figure out something" if the decline continues.

I'm extremely scared over the doctor's laid back attitude. Shouldn't he be testing for resistance and try another drug right away?

PS: they also don't understand how his other labs are "perfect". They said he appears "super healthy" in every other data and his liver function is so good, the nurse accused him of not taking the drugs at all.

PS2: we live in a small European country, not the US.

Thanks! B

Response from Dr. McGowan

Dear B,

Would not worry too much about the numbers at first. A viral load would be the best way to determine if the meds are working. Usually this will go down quickly in the first 2-4 weeks (even if there is drug resistant virus in the mix because all the susceptible virus will get killed off first). After that it is important to watch the HIV viral load closely every 4-6 weeks to be sure that it gets to an undetectable level. The yellow eyes on Reyataz was a good sign that he was taking his meds.

Just stick with the plan...as long as his resistance test pre-treatment was OK then the viral load tests will show if the meds are working and the CD4 counts will come up once the virus is suppressed. If the viral load goes down then rebounds up again or never gets to fully undetectable then another resistant test would be needed.

Keep encouraging him during these early days on treatment, he will appreciate it, Joe



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