Dr. Daar, I've been infected 8 months now and am part of a clinical trial to test the efficacy of early treatment. I'm in the non-treatment arm. My last labs show a dip below the 350 CD4 threshhold. If the August labs show that I'm still under 350 I'll be given the option of receiving treatment:truvada/kaletra. VL has consistently been low: 7K to 18K. In March:CD4 370/24%; April:435/24%; May:396/35%; June:359/31%; July:320/27% Also, during this time the neutrophil count has gone from 1900 to 1250. Given that neutrophils control bacterial and fungal growth, I'm worried about infections. Also, I have persistent sinus problems lately, scratchy throat, and red, itchy eyes. claritin helps some but I have a hunch it might be due to the hiv and corresponding depressed numbers. Are these lab values low given that I've been + for only 8 months? Is it correct that lab values jump around a lot in the first year of infection? What do you think of the side effects profile of the new kaletra formulation? I'm guessing that at some point this year I'll have to go on meds. Also, I don't smoke, drink in moderation & exercise. Thanks for your advice.

Thank you for your posting. Laboratory values bounce around throughout the course of disease and in particular during the first months to a year of infection. Because of this we tend to react to trends in the numbers and look at both the absolute number and percent CD4, the latter being somewhat more stable during the course of chronic infection. Based upon the numbers you report between March and July I am not completely convinced that there are any real trends. I say this because the percent CD4 is actually somewhat greater in July than it was in March and April. That being said, during these first months of infection all of these values are on the move and a bit difficult to interpret. Certainly it is not inappropriate to consider therapy if you are persistently less than 350 cells/uL after 9 to 12 months, but you likely have the luxury of time to be followed longer if you desire. It is really a judgement call as to when someone in your situation starts treatment and needs to be decided based upon many factors that you and your primary provider can discuss. It is possible that years from now your numbers could still be bouncing around the 300-350 value off therapy, so it is hard to say just how unusual it is to be where you are at this stage of disease.

The neutrophil count going from 1900 to 1250 is generally not alarming. We usually don't worry much about neutrophils unless they are persistently less than 750-1000. Consequently, I suspect your sinus symptoms are not related to these numbers. I would continue to pursue the management of these symptoms with your provider and I suspect this will all get sorted out.

The experience with the new formulation of Kaletra is somewhat limited but in general most people tolerate it very well. The most common symptoms are nausea, loose stools or diarrhea, but for most this is quite manageable. And, if for some reason it is more severe that that there are many other options, so I am optimistic that you will do very well.

I hope I addressed most of your questions.

Best, Eric