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rate of CD4 decline
Apr 18, 2012

Hi Doctor Young and McGowan, I was just diagnosed HIV+ at age 57. CD4 534, VL 21000. Doctor said "come back in 3 months for another blood test." Is there a general rule about how fast CD4 cells decline to the 500 threshold? Is there a typical rate of decline? Will my CD4 levels decrease faster than a younger person? I read somewhere that typically CD4 counts decline at 50-75 per year, which would mean that I'll be on meds in 6 months. I don't smoke, I exercise, and I eat well. Job stress and shift changes are negative factors, however. Should I stop drinking alcohol? (I have two drinks, 3 times per week.) Thanks!

Response from Dr. Young

Hi and thanks for posting.

Sorry to hear about your recent diagnosis. Starting medications, especially if your CD4 count is in the normal range is rarely an urgent issue. So waiting 3 months for a second set of labs isn't unreasonable at all. And BTW, it's ok to have an occasional drink (provided that you don't have active viral hepatitis B or C).

Having said that, there is increasing opinion (including last months US Treatment Guidelines) that suggests initiating treatment in people over the age of 50, irrespective of CD4 count. I happen to be one that recommends this for my patients. Additionally, I'd need more information (like CD4%) before concluding about the conviction in starting meds now or later, but rates of decline tend to be greater in "older" individuals. Further, it's almost certainly over interpreting the precision of the CD4 test if one tries to read significant differences between your current level (534) and the magical 500.

I hope that's helpful, BY



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