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VIRAL LOAD UP/CD4 DOWN...COMPUTER GLITCH?
Feb 24, 2004

I HAVE BEEN HIV POSITIVE FOR 6 1/2 YEARS. I HAVE DONE THE TANOFAVIR STUDY AND HAVE BEEN MED FREE FOR ALMOST 2 YEARS. I HAVE REMAINED VERY HEALTHY BUT NOW I HAVE SOME CONCERNS. MAY OF 2003 MY CD4 WAS HIGH AND MY VIRAL LOAD WAS NON-DETECTABLE (GREAT! AND THIS HAS BEEN THE CASE SINCE DAY 1), JULY OF 2003 MY CD4 WAS STILL HIGH AND MY VIRAL LOAD WAS 6900 (CONCERNED ABOUT THE VIRAL LOAD BUT OK BECAUSE I HAD BEEN MED FREE FOR A YEAR), NOW, JANUARY 2004 MY CD4 IS 210 (MAJOR DROP) AND I AM NOT SURE OF MY VIRAL LOAD (APRIL 2004 WILL BE 2 YEARS MED FREE)....WHAT DOES THIS MEAN? I AM PRETTY SURE THAT I NEED TO GO ON MEDICATIONS BUT MY CONCERN IS THAT MY NEW DOCTOR, THAT I HAVE ONLY BEEN TO TWICE, SAYS THAT ONCE A CD4 COUNT HITS 200 ONE IS AUTOMATICALLY DIAGNOSED WITH AIDS. I DON'T UNDERSTAND! AFTER HAVING THE SAME DOCTOR FOR 6 1/2 YEARS THEN MOVING TO ANOTHER STATE AND SEEING A NEW DOCTOR ONLY TWICE ON WHICH BOTH TIMES I HAVE GOTTEN SOME "NOT SO GOOD" NEWS, I AM NOT REAL SURE OF WHO TO TRUST OR BELIEVE. WHAT DO STATISTICS AND RESEARCH FACTS SAY? MY NEW DOCTOR SEEMS TO THINK THAT MY HIGH VIRAL LOAD TEST FROM JULY 2003 AND MY LOW CD4 FROM JANUARY 2004 ARE THE RESULT OF A COMPUTER GLITCH...IS THIS POSSIBLE? WHAT DO I DO? I HAVE CONSULTED WITH MY OLD DOCTOR AND SHE GAVE ME HOPE STATISTICALLY BUT WHAT DO I DO NOW? IS A CD4 DROP FROM 727 TO 210 IN THE MATTER OF 6 MONTHS POSSIBLE? IT'S MY UNDERSTANDING THAT ONE ON AN AVERAGE CAN ONLY DROP 100 A YEAR. PLEASE ADVISE! I DON'T UNDERSTAND ALL OF THIS NUMBER STUFF!

Response from Dr. Sherer

In general, patients who have good responses to ART, i.e. with long term viral load suppression and CD4 cells over 500 for 6 months or more, and then stop their medicines under the direction of their physician have an average drop of CD4 cells of 10-20/month, or 120-240 per year. That's only an average, so some have greater or lesser changes, and some more rapidly than others. Those with the fastest declines tended to have the lowest 'nadir' CD4 count before therapy, i.e. their lowest ever CD4 cell.

As you suggest, a drop of 717 to 210 is unusual in 6 months. You might ask if the percentage of CD4 cells changed as severely - sometimes there are other reasons to have a lower total lymphcyte count (of which one kind is the CD4 cell), like a viral infection or a vaccination.

So when a test result seems out of range, its reasonable for you and your doctor to repeat the test, i.e. the CD4 cell count. If indeed you have fallen to <350 CD4 cells, you and your doctor may want to consider resuming therapy with the same regimen that you did well on in the past.

The good news is that the vast majority of people in this situation (>90%) have an excellent response to the same regimen they were on before the interruption of therapy.

You have to be careful not to put too much weight on these numbers. They are certainly imporant and guide our decisions about therapy, but they are only one imporant issue among many, like how you feel and how well you have done over time.


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