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Viral Load and Prognosis
May 15, 2000

Hi,

I was just diagnosed with AIDS. My CD4 count is 37 with a VL of 31000. Prior to this I have never received any HIV medication. I was told by my doctor that my progression was slow. I have been reading messages from this forum and have noticed that when your CD4 count is this low you generally have a very high viral load. My question is have you seen cases like mine before, why would my viral load be this low and if so, what is generally the prognosis.

Thanks in advance

Response from Dr. Pavia

The best way to explain this is to go back to our basic understanding of viral load and CD4 counts and what they mean. CD4 count measures the degree of damage to the immune system, and 37 is pretty low, as you know. Viral load is best thought of as a measure of how fast that damage is occuring, or how many CD4 cells you will lose in a year. Of course this is a little simplified.

First we have to ask if the numbers are right. Usually you want to repeat the tests since CD4 cells can be falsely low for a number of reasons: infections, colds, bad handling of the specimen, low white blood counts. If the test was done while you were very sick, it needs to be repeates. Viral loads can be falsely low sometimes if you have a strain of HIV other thant the type most commonly found in the US and Europe, for instance if you were infected in Africa or Asia or by someone from those areas.

Assuming the numbers are correct, the most likely explanation is that you have been infected for a long time and it took many years to get to where you are. Given your low CD4 cells, you need treatment to reduce the viral load and allow your immune system to recover. You also need medications to prevent serious infections like PCP and MAC until your immune system recovers. Usually you would start something like Bactrim (Septra) and Azithromycin.

Given your relatively low viral load, it helps predict a good chance of long lasting response to antiviral drugs. It is important that the first regimen be strong enough and it is INCREDIBLY IMPORTANT that you are able to take the medications faithfully with out forgetting or missing.

You should do very well. Make sure you understand your treatment. Get actively involved. Make sure your doctors are good and expert in HIV. But remember, it is a partnership

Good luck to you Andrew T. Pavia, M.D.



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