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Progression to Aids within a year?

Jun 19, 2013

Hi Benjamin, thanks for all of your responses to everyone, they are very helpful.

I was diagnosed HIV positive on december 2012, my viral load and CD4 by february 2013 were 94500 and 6 per mililiter!! even though I have not been sick at all. I was put right away on treatment with Truvada en Efavirenz.

I supposed I had been taking care of myself since october 2011 when I began my sexual life at the age of 26; certainly despite my efforts something must have gone wrong.

After 3 months on treatment my viral load dimished to 157 but my CD4 count only raised to 41, which of course has been very perplexing. I still find it hard to believe that with such a low CD4 count I've not had any single AIDS OI and I'm scared if it would be waiting around the corner.

My doctor is not an HIV specialist, her explanations have been unclear and unkind. I just wonder what "circulating CD4" and "total count" means in her words. I did not asked her because of the shocking news.

I'd really appreciate your thoughts on my concerns. Thanks.

Response from Dr. Young

Hi and thank you for posting.

Seems to me that you're on a good track and trajectory.

First off, yes, it is entirely possible to progress to AIDS within a year of infection. This isn't the average, but then again, no single person is an average, they're just a person in a population of people-- people with different rates of disease progression. Your initial high viral load is one of several predictors (along with just plain bad luck) of rapid progression. There are indeed many individuals like you who are entirely asymptomatic despite years of infection or advanced immune suppression.

Nevertheless, people with advanced disease (ie., low CD4 counts), (particularly those who are asymptomatic and without OIs or other complications) do have a very good near-term prognosis, so long as they link to, and stay in care and can find the means to be adherent to well chosen HIV medications.

Your labs are indicative of just this- it was clearly time to start on medications; your viral load has dropped dramatically (from 96,000 to 157 is a 99.9% reduction in viral load - 3log10 in 3 months), and your CD4 absolute count has also increased significantly.

I wouldn't fret about the seemingly low CD4 count, as all the trends are right- and I'd expect to see continued increases over time. Indeed, examine your CD4 percentages; the increases in absolute count are likely mirrored in the percents.

As for your doctor-patient relationship- what's essential is to develop a trusting, non-judgmental relationship with your provider. With today's medicines (and your lack of AIDS complications), it matters less that she is a HIV/AIDS specialist, but rather one who stays up to date and is willing to consult specialists when necessary. Moreover, current issues in the care of positives has much more to do with preventive medicine and non-AIDS complications than with the older issues in the pre-treatment era. In this forecast for your health and successful aging with HIV, I'd encourage you (and your provider) to surf IAPAC's you'll find a provider-centric view of many of the new issues facing care providers and their patients.

I hope that helps, BY

hiv accute stage
adherance problem

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