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CD4 %
Apr 15, 2008

Dr. Bob

I was diagonised with AIDS & HBV & Hepatitis A exactly a year ago. My Dr. put me on HAART immediately. -CD4 count at the time was 70. -Viral load is now undetectable (was ~8000 at diagnosis). -While my CD4 count has risen to 145; my CD% has remained constant at 5% (was 5% at diagnosis and has stayed there to date). 1. What is happening? Has the virus caused extensive damage to my system beyond repair? I would have thought the CD4% would also go up as the CD4 count goes up. 2. At this rate how do I measure my AIDS progression? I read CD4s & Viral Load are predictors of progression of the disease.

Thank you for your time.

HHH

Response from Dr. Frascino

Hello HHH,

Without the benefit of reviewing your entire medical record and laboratory tests and performing a physical examination, it is difficult for me to offer a specific analysis or recommendations. I will make several comments that hopefully might help.

HIV/AIDS is a highly variable illness and there are many factors that influence how well someone will do on treatment. These factors are related to both the virus (viral strain, viral load, etc.) and the host (genetics, immune integrity, concurrent infections, etc.). Your AIDS condition is complicated by coinfection with hepatitis A and B. I have no way of determining how severe your hepatitis conditions were or if you've developed any significant liver damage or chronic hepatitis as a consequence of these infections. You might want to discuss this with your HIV specialist as this may explain why your CD4 counts have not gone up as expected.

Next, you report you are on HAART, but I do not know which antiretrovirals you are taking. The regimen appears to be working well virologically, as your HIV plasma viral load has dropped to undetectable levels. However, immunologically your CD4% has remained at 5% (even though your absolute CD4 count has improved from 70 to 145). Consequently there is still plenty of room for improvement. Your HIV specialist should evaluate any other potential factors contributing to your persistent immunodeficiency and lack of immune reconstitution despite the HIV plasma viral load being driven to undetectable levels. If no cause(s) can be determined, a change of antiretrovirals might be considered, depending on your resistance profile and tolerance.

Good luck.

Dr. Bob



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