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HIV Drug ResistanceHIV Drug Resistance
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1 yr. anniversary
Sep 7, 2004

Dear Dr., My Cd4 count went from 36 at first diagnosis to 511 in just one year! 3 months later, my cd4 count dipped to 408, although the vl is still undetectable. It was my first fasting bloodwork, and I'm wondering if that had anything to do with the dip. My wonderful doctor said not to worry, everything looks good, but I do worry. How high to cd4 counts go before they stablilize when someone started out so low (might I reach a cd4 level of 1,000 eventually?)--I was really sick when I was diagnosed. Thanks so much for all you do.

Response from Dr. Sherer

From what you tell me, I would agree with your doctor that this small decrease in the absolute number does not indicate any loss of effectiveness of the regimen by itself, and the lack of a viral load change from undetectable suggests that you and the regimen are doing well. Fasting is not known to alter CD4 cell counts, but many other things do, including the time of day in which they were drawn. You can check the reliability of a decrease or increase in CD4 cells by also looking at the trend (if any) in the CD4 percentage. A significant change in CD4 percent is above or below a 3% difference, and a significant change in the absolute CD4 count is 30% above or below, a threshold which your minor dip does not meet.

So you should relax as your doctor suggests and await the next tests, while continuing your excellent medication adherence. Now that you have done so well by closely watching and worrying about your viral load and CD4 cells, it may be time to introduce another important concept: Your health (mental and physical) is a great deal more, and more complex, than these two numbers. They remain important, even essential, for your future well-being, but so do other things. Maintain your vigil with good adherence...but you can allow yourself to relax and enjoy this life sometimes as well.

Med switch: resistance?
Bad Decision

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