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my CD4 is not increasing.
Mar 1, 2002

Dear Dr., I have been taking Duovir-N(a triple drug combination) from May-2001 onwards but still my CD4 count is not going above 156 in flow cytometer process used. Where am I going wrong?

Response from Dr. Pavia

In the United States, we are not familiar with what drugs are in "Duovir-N". It sounds like it might be a generic manufacturer's packaging of AZT/3TC and nevirapine, but I am only guessing.

The first question is whether the drugs are working on your virus. If the viral load has dropped to undetectable in the 9 months since starting, we would conclude that the drugs are working. If not, you may either have developed resistance, been infected with a resistant virus, or perhaps the drugs are not what they appear to be.

If you have had a drop in your virus but the absolute number of CD4 cells (or CD4 count) has not gone up yet, you could still be having a good response if you look at the CD4 percent. If the immune system improves and the percent of CD4 cells goes up, but the white blood count goes down, then it may appear the the CD4 count is stable.

Lastly, there are a group of people who have little or no improvement in CD 4 on succcessful antiviral therapy. This is not really understood. Nor do we know what level of CD4 count is totally safe in this setting, although over 100 is reassuring and over 200 would be better.

Hope this helps

ATP


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