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confusing numbers

Aug 28, 2012

Dear Dr. Young, I am a 63 year old man who tested positibe in May for HIV, after not having been tested since 1999. My cd4 count was 174, which to me indicates I had been infected for perhaps years, yet my viral load was 497,000 which indicates perhaps a more recent acute infection. Can you explain this anomaly? By the way, after one month on Atripla MY CD4 WAS 223, vl was 3050 and percentage went from 16% to 23%. Thank you very much.

Response from Dr. Young

Hello and thanks for posting.

One really can't use either a CD4 or viral load to accurately time how long you've been infected. While in general terms, people infected longer have lower CD4s and higher viral loads, people who are *very* recently infected (ie., seroconverting) also have very high viral loads.

I don't think that there's any confusion about your pair of labs- the lower CD4 count is indeed consistent with a somewhat longer period of infection. It's not unusual (indeed, it's an ominous sign) at all to see people with AIDS-defining CD4s to have high HIV viral loads like yours.

On a positive note, it does look like you've have a terrific initial response to your Atripla regimen. Keep up the great work with the adherence, and please feel free to write me back anytime.


Starting Medicine

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