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CD4 count and AIDS
Nov 5, 1996

Recently a friends CD4 count dropped to 130 and his viral load rose to 41000. He had been on AZT for a number of years and maintained a CD4 count of around 300. When his count dropped to 130, his doctor switched him to a combination therapy. His count rose to 290 and the viral load has dropped to an undetectable level. Is he still categorized has progressing to AIDS? What is his prognosis with the combination therapy? It seems most things I've read address people with counts higher than 300 when starting the combination therapy. He has not been diagnosed with any other opportunistic diseases, but lately he has been forgetful.

Response from Dr. Cohen

If you've ever had a CD4 count of less than 200, then you have AIDS according to the 1993 CDC definition of AIDS. That's really more of a bureaucratic definition than a medical one, though. Obviously, if your friend's CD4 count went from 130 to 290 with antiretroviral therapy, then he's much better off now than he was before. He should also be less likely to develop complications at this point than he was before.

I can't tell you what his prognosis is other than to say that it improved when his viral load dropped and his CD4 count rose. Now it is partly dependent on how long he can maintain this response.

You're right that many studies have looked at the effect of antiretroviral therapy on people with higher CD4 counts, but there have also been studies showing a benefit to protease inhibitors and combination therapy in people with low counts. Ritonavir, for example, was shown to delay progression and prolong survival in people with CD4 counts less than 100.

Viral load and body fluids
Impact of lower viral load on t-cells?

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