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undetectable viral load, declining CD4s
Jul 21, 2005

Dear Dr. I've been HIV+ since March this year and due to a very severe zeroconversion my Dr put me on Kaletra and Combivir which made my viral load undetectable and my CD4's jump from 10 to 290 in a few weeks. However, about 6 weeks after starting treatment my CD4's started declining again and are now down to 70 (5%). My doctor does not have an explanation for this since all my other values are very normal. He has suggested that the combination I am on might also be supressing my CD4's and that I should try changing my medication? Is this a likely cause? Or is it possible that my CD4's just need longer to recover?

Response from Dr. Conway

This is a complicated question. The fact that I cannot give you a single straight answer reflects our general lack of insight into the immune system, especially in the first year of HIV infection. As all of this happened over 6 weeks, I would tend to wait as long as 6 months before doing anything, as long as your viral load is steadily going down...The fact that your CD4 count was as low as 10 during acute seroconversion is unusual in itself, and tells me that the initial interaction between your virus and your immune system very much favored the virus. The initial rise in CD4 count that was noted was probably redistirbution of pre-formed cells. It may take many, many months of an undetectable viral load for your body to regain the abillity to make its own CD4 cells in large quantities again.

If I were you, I would just hang in there, as long as your viral load is steadily decreasing.



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