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high CD4 and low VL. Meds?

Nov 30, 2014

Dear Dr Young, I am Kevin from (Rotterdam) the Netherlands and I am HIV + for around thee years. My CD4 count is always between 500 and 700 and my viral is always quit low. This are my labs result during the recent 3 years.

CD4: 650. VL 780 (2011) CD4: 670 Vl 12.000 (2012) CD4: 520 VL 9500 (2013 CD4: 690 VL 1100 (2014)

I have a few questions regarding this lab results.

1) Because my viral load is quit low (especially the last one) can you say that the virus is 'not really active' in my body? As my doc says. Can this mean that I'm the type of person that is capable of holding his CD4 count above 500Tcells for 10 years. This would be great news for me if this could be true ,because I really don't have any symtomp and I really 'forget' that I'm HIV + which is great for my mental health.

2. Do u believe that with my low viral load and high CD4 counts that I should think about treatment? I mean, because I have a low viral load you could argue that my body is very capable of surprising the HIV by it's own. The meds that are around are good but I'm afraid that perhaps within 10 years these meds show that do harm to my kidneys or vains. Do you think with my lab results there is a need to start? In terms of preventing future damage by the virus.

3. There is a lot of confusion about 'long term' damage of the meds nowadays around. My doc says that it they really don't know what the long side effects of the new meds are because they are quit new. But some experts says that the long term side effects of the new meds are not considered be an issue. What is true?

I'm looking forward to your answers. Sorry for my not so good english by the way. I hope you'll understand.

Regards,

Kevin.

Response from Dr. Young

Hello and thanks for posting.

HIV medications are recommended for most people living with HIV, irrespective of CD4 count or viral load. Your's is possibly a special case, with relatively low viral load (I generally think of low viral loads as those persistently below 1000) and normal-range CD4.

Here's what the US DHHS Panel says about your situation:

"There are limited data on how to manage these individuals. Given potential harm associated with uncontrolled HIV replication, many of the preceding arguments for early therapy likely apply to nonprogressors who have consistently detectable viremia (i.e., HIV RNA >200 to 1000 copies/mL). Given that ongoing HIV replication occurs even in controllers, ART is also recommended for those rare controllers with evidence of disease progression, as defined by declining CD4 counts or development of HIV-related complications. The Panel has no recommendations on managing controllers with high CD4 counts, although the fact that ART reduces the level of inflammation in this setting suggests that treatment may be beneficial."

I'm in agreement that the risk of uncontrolled HIV replication includes ongoing inflammation; I'd want to know if there has been any trend in decline in CD4% or CD4:CD8 ratio; your markers of inflammation, like CRP or ESR. If there's anything amiss there (or perhaps, even if not), I'd recommend treatment.

I hope that helps and feel free to write back. BY



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