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CD4 and Viral Load improvements in 3 weeks
Jul 10, 2012

Hi Doctor Henry

I would appreciate your opinion on the following.

Seven weeks ago I was sent to hospital by my GP having developed a serious illness in the weeks preceding. Within 2 days of admission I was diagnosed with PCP pneumonia and it was suggested (implored in fact) that I take an HIV test immediately and was told it would likely be positive. This came as quite a shock as I don't fall into any high risk category.

My first counts were taken on the same day I was started on high dose co-trimoxazole and was at the peak of the illness, the CD4 count was 25 and the Viral Load 500,000 copies. HAART treatment commenced seven days later (Truvada, Norvir, Atanzanavir.

I had a follow up 1 week after discharge from hospital having recovered from the PCP. I had then been taking HAART for 20 days and the following improvements in counts were observed, CD4 185 - Viral Load 1000 copies.

Do you think it is likely that my nadir CD$ count was in fact higher than 25? This improvement seems disproportionate to the norm in terms of improvement. Could the PCP have had a negative effect on the count, and if so what we be your best estimate of the true position.

Many thanks in advance

Response from Dr. Henry

Though the CD4 count may be lower in the setting of an acute AIDS-related OI that is the true nadir that underscores your risk for future complication unless effective treatment is started (as relieved to have you report your current regimen and initial expected good response to treatment). Often patients will have dramatic improvements in situations like yours but there is still variation such that perhaps 10-20% have minimal or slow CD4 recovery for a variety of reasons (ie age, thymus atrophy, continued immune activation, genetics, et cetera) so you are indeed off to a good start. KH

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