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Lab Testing and Starting of Treatment
Aug 28, 2011

August 6th Hospitalized for a week with PCP, on Aug 8th, CD4 124, 14 % Was in hospital for one week and received many IV antibiotics along with pill antibiotics. Sent home on Aug 12th and taking Bactrim DS 2 tabs every 8 hours for 2 weeks and then one tab for at least 3 months. Also took Levofloxacin 750 mg tabs for 12 days (1 a day) and 40 mg of prednisone for 5 days and 20 mg for 5 days. Had another CD4 test done on Aug 17th, CD4 of 816, and 29 %, this test was done the morning prior to starting antivirals of Reyataz, Truvada, and Norvir, the PCP hospitalization and the Aug 8th CD4 tests were done at Akron City Hospital in Ohio. All other testing that I am referring to and doctors seen are at the Veterans Admin Hospital in Cleveland. My history of CD4 and CD4 % are as follows: Aug 8th CD4 124 14 % Viral Load 147,232 CD3/8 N/A CD3/8 % N/A Akron City Hospital Aug 17 816 29 85,627 1297 46 Cleveland VA Hospital Jul 20 569 14 41,802 2373 60 for all the remainders Apr 25 1362 21 147,962 4135 62 Mar 7 845 18 108,853 2943 64

Dec 8 2010 1343 23 107,967 3538 62 Sep 15 1985 26 35,268 4472 60 Jun 23 1459 27 19,518 3235 59 Jan 20 1737 29 20,197 3534 59

Sep 16 2009 2115 33 13517 3269 51 In case it may matter I had my spleen removed in August of 2003 due to a severe accident. I am having another CD4 count performed next month September 2011 and seeing the doctor again next month. Also the reason I am on the Reyataz, Truvada, and Norvir is because of the testing that was performed in 2008 I showed a resistance to one of the drugs in Atripla. (I don't want you think I am trying to 2nd guess my doctor because I do have faith in her judgement.) My question though is do you think we made the correct decision in starting therapy just now or do you believe I could have waited. The way my CD4 count, percentages, and viral load bounces around just confuses me to no end. I was under the impression that the viral load would increase and the CD4 would decrease and wouldn't go up and down the way mine has been doing. Any light you may shine on this issue would be appreciated. Oh I was diagnosed in 2008 and had high CD4 counts, low Viral loads. Thank you very much for any help you may provide and Thank You for the response to my earlier message, it was appreciated. David.

Response from Dr. Frascino

Hello.

Yes, you absolutely made the correct decision to begin combination antiretroviral therapy! Your bout with PCP (as well as CD4 count below 200 and CD4% less than 14%) qualify you for a full AIDS diagnosis (as opposed to HIV positive). An AIDS diagnosis is an absolute indication to begin antiretroviral treatment.

Your wildly fluctuating CD4 and CD4% can be explained by your intercurrent opportunistic infection (PCP), use of corticosteroids and your splenectomy.

Your CD4% of 14% on July 20 indicated an increased risk for PCP, which, unfortunately, you contracted.

Not having a spleen can affect your test results. The CD4% is the more accurate measure of immune function particularly in splenectomized HIVers.

Dr. Bob



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