|combivir and sustiva
Apr 13, 2004
Response from Dr. Sherer
In most cases, when an ART regimen is succesful at lowering the virus load to below the level of detection, the CD4 cell count responds by rising. People who tend to have lesser increases in CD4 cells are those with more advanced disease when they start ART. The same indiviuals may also take longer to achieve full viral load suppression and optimal CD4 cell responses. Sometimes a CD4 cell response is blunted due to another infection or to another drug that causes suppression of the normal development of white blood cells and lymphocytes.
Also, you might ask your doctor whether the percentage of CD4 cells has changed, in spite of no change in the absolute number of CD4 cells. An increase of > 3% in the percentage of CD4 cells would suggest that you are seeing a benefit in your T cells.
The regimen you are taking is well known for having good responses in high proportions of patients, including those with more advanced disease at the time therapy is initiated.
So there is nothing wrong with your regimen. Sometimes the phenomenon that you describe occurs without a clear explanation. My advice would be to stay fully adherent to this regimen and allow for more time to pass for your CD4 cells to respond, and to talk to your doctor about this problem.
There are no proven strategies that lead to an effective rise in your CD4 cells. Some physicians might try a switch in the regimen, e.g. to a boosted protease inhibitor-based regimen, but that is an unproven strategy. Interleukin-II is known to raise CD4 cells by 50-100 cells or more while one is taking it, but there are significant side effects, and the CD4 cell count falls back to baseline when the drug is no longer taken.
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