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Long term risk of low CD4 in the setting of undetectable viral load.

May 28, 2014

Hi Dr Ben, I have been positive for 6 years, and undetectable for 5, but my CD4 has struggled around 250 for that period. The percentage has hovered around 28. It has recently come to light through investigation of my medical records - for an unrelated condition; suspected but never confirmed skin sarcodosis 13 years ago, that my immune system was on the low end then as well with a WBC 2.7 and total lymphocytes 0.46. However, I tested HIV negative a year after these tests were done. It should also be noted, lung x-rays came back negative and the single smallish lesion above my eye cleared up after a few years, possibly helped by methotrexate application. Have you ever come across such low numbers in a HIV free context? What are the implicaions for my long term health, i.e., cancer risk, from being naturally neutropenic? These concerns are amplified by the recent study showing a threefold increased cancer risk for virally suppressed with CD4 less than 200 relative to above 500. I'm otherwise in excellent health. Has always, thank you for your time. >M.

Response from Dr. Young

Hello M, and thanks for posting.

I have managed a few patients like you in my years, but truth be told, there are only a few. If we can extrapolate from the HIV/AIDS lessons about CD4s, your risk of complications only really rises when your counts are below 200 or 15%.

It's probably prudent (as it is in the HIV+ population) to be attentive to standard cancer screening recommendations- such as colonoscopy, PAP smears, etc. If your counts should drop below these thresholds, then preventive medical interventions like Bactrim prophylaxis (to prevent Pneumocystis pneumonia) is a reasonable thing.

Hope that helps, BY



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