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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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DHEA low & lower cd4
May 27, 2011

Hi Doc, Thanks for your help. I started Atripla since january. One month ago I got my results and I was already undectable and with 22% of CD4 (309 CD4). I started my treatment at 250 CD4s. Today I got my new results and it says that my cd4 are 282 and 20%. All the rest are ok (colesterol, Triglicerides, blood work, etc) but the only thing out of range was de DHEA (83 mcg/dl). I am still waiting for my viral load. I never missed a dose but havent been able to take the pill at the exact same time. I have been talking it between 10 pm and 1 am max. I have been going thru a lot of stress (work, treatment and hoping to be ok). Is this normal? that cd4 are going down since one month ago i was undetectable? and never missed a dose? I am very worried about it. Please help me. Thank you very much.

Response from Dr. Henry

The initial response of the CD4 count to starting effective HIV treatment is variable-on average the level goes up but a significant fraction (ie 20%) initially remain in the same range. The CD4 count is highly variable even in HIV-negative individuals so can be frustrating to follow short term CD4 levels (I am more interested in long term trend including what happens to CD4%). The direct effectiveness of the ART regimen is best assessed by the viral load. CD4 response involves many factors including age, genetics, status/size/function of thymus gland, degree of immune activation-and others. I remain uncertain what to do with the DHEA level-it is not usually measured in most HIV practices and the benefits/harm from supplementation have not been well characterized. KH

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