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UNDETECTED VIRAL LOAD
Mar 30, 2009

My viral load is undetected since i started ART in Sept 2008 but my CD4 Count is low at 159. I on a 12 hourly dose of Lamivudine,Zidovudine,Nevirapine combined and Cotrimoxazole 2 tabs daily.I take a dose of Vit C 500mg and Selinum 50mgc daily and other multivitamins. I have no opportunistic infection. What do i do to increase my CD4 count?

Response from Dr. Frascino

Hello,

This is something you should discuss with your HIV specialist physician. If your HIV plasma viral load has been suppressed to undetectable levels for a considerable period of time and there has been no appreciable increase in your absolutely CD4 cell count and/or CD4%, he will need to evaluate you to see if there are any reasons other than HIV for your lack of immune reconstitution (increasing CD4 count). If no cause can be determined, you might consider switching your antiretroviral regimen to a protease inhibitor-containing one with two new nucleoside reverse transcriptase inhibitors. Kaletra (ritonavir-boosted lopinavir) plus Truvada (emtricitabine plus tenofovir) would be one possibility, assuming you do not have resistance to any of these agents. I should also mention not everyone responds to combination antiretroviral medications the same way. Some folks for whatever reason (and some of these reasons we don't yet understand) are unable to significantly boost their CD4 numbers even when on effective antiretroviral treatment. That's one of the reasons we are advocating for beginning antiretroviral treatment earlier. The guidelines now suggest starting treatment when the CD4 count drops to 350. Some of us recommend starting even earlier, 500 or above, to preserve immune function and decrease immune activation.

My best advice to you is to work closely with your HIV specialist. We have several things to try that may help. They don't always work, but they are worth trying.

Good luck.

Dr. Bob



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