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Behold! They shall all be as nice!
Mar 15, 2007

Hello to the coolest HIV specialist on the planet,

First the serious question! Seeing how nice of a person u r and how appreciative u r of HIV patients dont you think it makes sense that we enforce a law to make all HIV specialists HIV+ like yourself? Or are you just plain nice even before being virally enhanced?

Now the trivial question. Here is my test results over a long period, they dont make sense to my new doctor and this is the problem! Diagnosed on March 2005 possibly 4 months after infection CD4 780 VL 36000 Three months later CD4 678 VL 60,000 Three months later CD4 648 VL 85,000 Now there was a long break with no testing or follow up since I moved to another country, this period lasted for about 7-8 months or so . First new results CD4 550 VL 686 and a percentage of 24% now does this mean anything? A sudden drop of viral load! Three months later CD4 349 VL 17,000 and percentage of 22% yet another strange number, this time the CD4!! At the period of this sample withdrawal I was having a cold and had hepatitis and another vaccination for three diseases, cant remember the name. I also wasnt on any cold medication. My doctor was concerned and decided to run a control test and the results are CD4 502 VL 16254 and percentage 26%

My doctor said it seems like the 686 viral load was a wrong result! In addition, the second test and the control seem to be the correct ones. But he didnt explain why the large CD4 variation occurred. He also said that it seems like treatment, guidelines are changing and that we might be better off starting treatment early! Which means I dont have to wait for a CD4 that is as low as 250 or even 350! I have subtype D which as far as I read is the deadliest of all the strains! Is this correct? and do you think this warrants starting of treatment earlier? And how early do u think is best? Except for an increased fatigue I remain very healthy.

Thanks for your reply! And consider the mass HIV specialists infection programIm not so rich, but I can certainly donate virus: P

Response from Dr. Frascino

Hello,

When monitoring CD4 counts, HIV plasma viral loads and CD4 percentages, it's important to look for overall trends, rather than focusing on one specific (and often spurious) number. Your trend has been one of persistent CD4 decline with elevated plasma viral load consistent with untreated HIV disease. I agree the 686 viral load result is most likely spurious. The 349 CD4 count could reflect concurrent infection (your "cold").

Regarding treatment, as HIV therapies improve with the availability of newer and better tolerated, more convenient and less toxic medications, I would anticipate the treatment guidelines would once again move in the direction of earlier intervention. Technically speaking, you don't have to wait for any specific CD4 count to begin treatment. However, the decision you and your HIV specialist need to make is how to balance the beneficial effects of treatment (immune preservation or restoration, improved CD4 count, depression of viral load, etc.) against the potential short- and long-term drug side effects and toxicities. When it comes to designing and starting an HIV regimen, the motto must be: "One Size Fits One!" The treatment and when to start it must be tailored to the particular patient's case and desires. The guidelines are just that: "guidelines," not mandates!

Next, unlike the uncanny and intimate link between being part of the Bush-Cheney administration and pathological lying, there is no correlation between being virally enhanced and niceness.

Stay well.

Dr. Bob



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