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Undetectable Viral Load but CD4 is still decreasing, can you help? (DISCORDANT RESPONSE TO ANTIRETROVIRAL THERAPY, 2011) (CD4 COUNTS NOT INCREASING DESPITE UNDETECTABLE VIRAL LOAD, 2011)
May 20, 2011

Hi Dr Bob, can you help? My partner has been taking Atripla since december and for the last couple of months has had a undectable viral load, two months a go his CD4 count was 120, then since then it has been dropping and yesterday was told it was only 24, but with a undectable viral load still. We are from the UK (Newcastle upon Tyne) and have excllent health care, my partner has been tested for drug resistance and hep b and c and it clear, also all his other blood tests are fine, he has never missed a tablet, our doctor is baffled and has never seen this happen before. We are togo to the hospital next week (we have access to treatment at a local clinic) for further tests, we are extremly worried. Have you any advice? help? He is very well and has no other illnesses apart from HIV. I no you have had similar questions, ive serached the site but couldnt find the answers to my question. I am worried incase he will be ill.

Thanks Dr Bob, love Annie from the UK

x

Response from Dr. Frascino

Hello,

Your partner is experiencing a discordant response to his antiretroviral regimen (Atripla). His virologic response is excellent, as his HIV plasma viral load is undetectable. However, his immunological response remains poor, as his CD4 count continues to fall. If he's been thoroughly evaluated for opportunistic processes that might affect CD4 counts and none was found, I would recommend:

1. Switch the antiretroviral regimen to a ritonavir-boosted protease inhibitor plus Truvada (emtricitabine plus tenofovir).

2. Consider adding maraviroc, as a pilot study did suggest a CD4 benefit; however, this has not yet been confirmed with other clinical trials.

3. Another option is to consider IL-7 (interleukin-7), as another pilot study showed increased naive and memory CD4 and CD8 cells with this therapy. Additional clinical trials are in progress.

4. Some HIV specialists have used statins in situations like this. Statins may decrease immune activation and inflammation, thereby allowing CD4 counts to increase.

Also, see link below.

Good luck to you and your partner. Write back with a follow-up report if he tries any of the above suggestions.

Dr. Bob

CD Count. (CD4 COUNTS NOT INCREASING DESPITE UNDETECTABLE VIRAL LOAD, 2010) (LACK OF CD4 RESPONSE DESPITE TREATMENT, 2010) May 24, 2010



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