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Can Viral Load and CD4 counts be used to decide who got infected first?
Dec 10, 2010

My wife and I recently tested positive to HIV. Her Viral load was 7800, and mine was 3300. Her CD4 count was 350 and mine was 559.We are both asymptomatic and our Dr has recommended "wait" with respect to taking ARVs. Questions: 1. Can Viral Load and CD4 counts be used to decide who got infected first? Just wondering, so I need to know the truth to avoid misunderstandings 2. I understand that viral load <10,000 is not too bad and >100,000 is kind of bad, and CD4 <350 is bad. With this info (if correct), should my wife go on ARV immediately or we wait for the next few tests? 3. What of me? Thank you Dr. I know you are very busy so I will be patient till I get an answer from the experts.

Response from Dr. Frascino

Hi,

1. Not precisely. In general lower CD4 counts would suggest more long-standing infection. Viral loads are not helpful in this regard.

2. I would suggest you both consider beginning antiretroviral therapy without delay. Current published guidelines recommend beginning treatment when the CD4 count falls below 500. However, many HIV specialists, including yours truly, recommend considering beginning antiretrovirals even with CD4 counts above 500 to prevent damaging immune activation and to preserve immune function.

You can read much more about guidelines and opinions on when to begin antiretroviral therapy in the archives of this forum. Have a look.

Good luck to both of you.

Dr. Bob



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