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Ron's multi-part question
Apr 16, 2001

I was diagnosed HIV positive in September of 2000. My first set of lab results were t-cells: 318 and viral load: 5500. One month later another round of labs was done and the results were t-cells: 524 and viral load 24,000. The last set of labs run four months later were t-cells: 564 and viral load: 8400. I am currently on no anti-retroviral therapy. What is the explanation for such a high jump in my t-cell count from one month to the next and then a steady increase in t-cell count and decrease in viral load? My doctor says that I can put off therapy for a while under the new NIH treatment guidelines and I agreee with her. But why the erratic changes in numbers. Secondly...I had posted this question once before and I think it was too sticky for anyone to touch, so I will try again. With all that is coming out now from Merck, GlaxoSmithKline and other entities researching vaccines. (Especially the work of Dr. Barbara Ensoli in Italy), what do you think is the best case scenario for a viable, available therapeutic vaccine being available in say five years? ten years? (I will take an answer based solely on what you have been hearing and strictly in your personal opinion.) I am very optimistic about it. You?

Response from Dr. Cohen

Well - optimism is easy. Whether warranted is hard to know of course - the vaccine work is just so early on that it is hard to know what advances and disappointment await us. We have no effective vaccine for treatment now - but I agree very smart people are using more effective tools now to design something that has a much better chance of working. So sure - in 5 years I'd put the odds of something effective being found as very good. However, that and a quarter will get you not much these days...

As for your labs, CD4 counts do bounce around - it is one of the more frustrating parts when relying on this test for major decisions. But there are a few reasons why we see this - one is that the body has a variable number of cells floating around day to day hour to hour and so this sample here from your left arm may have a different amount than what is floating around later that same day. In addition, there can be some variability in how the test measures cells - so when studies are done taking the same tube of blood and running it 5 times - there is bounce. And there is variation from lab to lab - were these done in the same lab? Finally there can be human factors - like did the sample with a lower count sit around in the truck longer on the way to the lab - and the other samples didn't? Was there a snow storm that delayed the shipment?? One way we handle this bounce is to also look at the CD4 percent - this measurement has less bounce and may be more helpful. But sometimes we just repeat a test to get a sense of what you usually have - since we can't always know which result is the more accurate without repeating it.

Another reason for variation in both CD4 counts and a viral load can be illness - a illness like a herpes outbreak or respiratory infection might increase the viral load - certainly in the range of variation you are seeing.

But all in all it seems like your average CD4 count is over 500 and your viral load is about 5 to 10 thousand. And yes the guidelines do suggest that you can safely delay meds - since the body can cope with those levels without meds for some time to come...

And hopefully while you are monitoring - a vaccine trial might come along that intrigues you - and your participation might help us learn if our optimism is warranted.



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