|When variances are no longer variances but trends
Jul 16, 2010
I have been living with HIV for 10 years. Since 2000, I have been undetectable. I started with a Tcell between 500-550 and a viral load less then 170,000. I dont remember my percent.A couple of years in, I was concerned about facial wasting with Zerit, so my doctor switched me to a combination including Viread and Videx. Though I remained undetectable, my % started dropping all the way to 17% with a Tcell count around 375 or so. I knew something was wrong well before that but my doctors wouldnt listen. That was follwed by a study that was released about the issues with using those medicines together. A new doctor took me off those and I have been on Norvir, Reyataz, and Epzicom ever since. It took many years, but my % raised to 40% with my Tcells hovering between 600-1000. Over my last 4-5 tests, my % has dropped from 40% to 30%. Not up and down, just down. I realize this is still within normal ranges, but at what point should I be concerned that this is a trend and that something else may be going on such as a Kidney issue? My doctor so far doesnt seem particularly concerned. I just dont want the same thing to happen where my immune system is damaged because doctors take too long to act. What direction do you recommend if any? Thanks.
| Response from Dr. Henry
The absolute fluctuations of CD4 count/% are often greater with higher levels so your situation is not that uncommon (can be seen in general population as well). There is a diurnal fluctuation than is influenced by sleep cycles/day/night and stress. At the high levels you have been running no clear adverse clinical implications. You may want to have blood drawn at same time each visit for a while (assuming you are on a steady sleep cycle) to see if the fluctuations lessen. Use of drugs with corticosteroids in them (including nasal/pulmonary sprays) can also influence CD4 counts in some patients on protease inhibitors. Your HIV regimen has not had particular problems with CD4 variations to my knowledge. KH
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