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Dec 31, 2004

I was just diagnosed hiv+ last mnth and the Dr. said that I was doing great but my CD4 was 437. And on the paper it says out of 1500. How does my DR figureI'm doing great?

Response from Dr. Sherer

The range of a normal CD4 cell count varies from lab to lab, and is generally 800 - 1200 or more. Most patients, e.g. 2/3 of people with HIV, lose about 100 CD4 cells per year on average. A minority have more rapid CD4 cell loss and disease progression.

As your doctor probably mentioned to you, current guidelines suggest that treatment be started when the CD4 cell count is in the range of 200 - 350 cells. Your doctor may have meant that no treatment is required at this time. The level of your viral load would also be an important factor to consider regarding the need for treatment; the current HHS Guidelines suggest that you and your doctor consider treatment (ART) if the viral load is above 100,000 copies/ml.

Also of value would be two other peices of information: The percent of CD4 cells (i.e. the percent of CD4 cells compared to all lymphocytes); in general, 14% CD4 cells corresponds to an absolute count of 200 cells/ml, and 30% corresponds to an absolute count of 500. Hence your percent would be expected to be around 25-30%. This number corroborates the level of the absolute CD4 cell count.

The other useful information is the trends in both the CD4 cell count and the viral load (VL) over time. You and your doctor will get a sense of the trends in CD4 and VL when you obtain 2 more values over the next few months. High and stable CD4 cells, coupled with a low and stable viral load, would suggest a less rapid disease course. On the other hand, rapidly falling CD4 cells, and/or rapidly rising viral loads (to over 100,000 copies/ml), would suggest a more aggressive course, and may lead your doctor to advise ART sooner.

It's not 'great' to have HIV, but the CD4 count you are starting with is to your advantage. I urge you to talk through these issues with your doctor, as it will help you tremendously to understand the disease and the issues that you and your doctor will deal with during your treatment.

Undetectable for years: what's happening now?

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