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Seroconverted ~2.5 yrs ago, CD4=330, VLoad=1,000. Start treatment?
Mar 27, 1997

I'm sure you've gotten similar questions in the past, but I couldn't find an exact match to my situation among previous answers, so here goes my question: I was diagnosed HIV+ 2 mos ago and I'm 95% certain that I contracted the virus about 2 1/2 yrs ago. My doctor was a bit surprised that, even though I have a viral load of only 1,000, my CD4 cell count is 330/mm3. He says there are 3 possible reasons for the low CD4 cell count: (1) I have a strain HIV that is particularly virulent and has therefore savaged my immune system quickly, (2) I was actually infected much earlier than 2 1/2 yrs ago, or(3) I happened to have a cold or the flu on the day my bloodwork was done. I have two questions: Are my numbers really that unusual (low viral load w/ low CD4 count)? With these numbers, do you agree with the recommendation that I hit hard and early and begin triple-drug combination therapy, or should I wait until my immune system gets worse?

Response from Dr. Cohen

I don't think you're all that unusual, just lucky (to have a low viral load, that is). While most people would have a higher viral load at your CD4 count, some people settle out at relatively low counts and remain stable there, presumably because their viral load is low.

I don't think that theory #1 is likely. We generally don't see people's immune system getting rapidly "savaged" unless they have a pretty high viral load. Theories #2 and 3 are possible, but you may never know the answer, so it's best to deal with the information you have in hand.

As for what to do, it never hurts to hit hard no matter what your viral load is. It's just a little less urgent when your viral load is low. The issues of when to start and how hard to hit have been addressed in a number of recent answers, as well as in recent issues of The Hopkins HIV Report, which can be found on The Body.



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