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How long do they have to live?
Oct 4, 2004

family member has just been diagnosed with HIV. Their T cell count is 650. How long until AIDS develops?

Response from Dr. Sherer

It's not possible to answer this question definitively, but some information is useful in approaching the question. The CD4 count suggests a more recent infection, or slow progression of infection longer ago. The average duration between infection and onset of symptoms in the United States and Western Europe is 10 years; recent evidence suggests that this duration may be shorter by 30-50% in the developing world.

Another way to gauge the likelihood of disease progression is by trends over time in the CD4 cell count. The average annual decline in CD4 cells is around 100 cells, but there is considerable variability; those with higher viral loads (particularly in excess of 100,000 copies/ml) are likely to have more rapid progression, and more rapid decline in CD4 cells. Generally, two thirds of persons with HIV infection have a slower decline in CD4 cells and slower onset of clinical illness, and one third have more rapid disease progression. Over time, one can gauge the rapidity of disease progression with serial CD4 cell counts and viral loads, and provide a more informed answer for this individual.

And to end on an optimistic note, if antiretroviral therapy is started at the appropriate time, i.e. when the CD4 cells are in the range of 350 CD4 cells, and adherence and tolerability are not problems, as can occur in 50-80% of patients, the answer may well be that AIDS never develops, or at least is forestalled for 5 years or longer. You and your family member would benefit by asking this question of his or her physician, and following up with additional questions to be sure that all important issues are discussed.

Low VL with Kaletra

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