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To Dr Brian again
Nov 17, 2004

Dear Dr. First of all many thanks for your quick reply AGAIN. So I asked you yesterday about the switching the Stocrin to Viramune because of pregnancy, so yes, my CD4 is 721 (when I started drugs 7 years ago it was 3 !!!) So I guess there are no risks for me since my cd4 is high right? I had for the past year a cd4 of 800 and even 900 and on the last test I took it was 721, I got a bit panicked but my dr said I shouldn't be worried because as long as its above 500 it's really good, he told me that the fact my cd4 was 900 and now its 721 doesn't mean a bad direction , he said that cd4 gets up and down all the time its depends with my mood or if i had the flu or diarehha it can also cause the cd4 get a bit down...so what do you say? iIshouldn't have a reason to be worry , right? my vl shows 0 for alot 3 years and my dr says its realy great even if the cd4 got a bit down , is that right? One more question i took for a long time the Zerit and my dr switched it to Viread so i am with viread for about 9 month, my dr say that he is real optimist regarding the lipo cause while I took the Zerit the blood test showed very high level of fat but now its comltly drop into a normal level of fat, is that a realy good sign?

I also wanted to know about immunization against hepatitic , is this really neccesary? my dr says I should take it regardless to the hiv as it can protect me from getting problems with the liver. I must said that even i am taking Stocrin for long time the blood test shows that the liver function just great ...

Response from Dr. Conway

The CD4 varying between 700 - 900 is not a big deal at all, as it just represents some level of natural variation within the normal range. This does not indicate immune disease progression, as long as the CD4 cell percentage is relatively constant. However, at that CD4 count, you should probably NOT go on Viramune as your risk of severe liver toxicity exceeds 10%, especially as you are a woman.

The improvement in your lipid profile is encouraging, and is often seen in people who switch from Zerit to Viread.

Finally, hepatitis vaccines are a really good idea, especially with your immune system being in such good shape, increasing the chance that the vaccine will work.



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