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Hello again, Doctor!
Jul 18, 2001

First of all, thank you for all of the wonderful work that you are your colleagues are doing here on "The Body". I have a follow-up question to one I addressed to you on April 16. I have recently been back to my doctor for my three month HIV evaluation and received a mixed bag of information. The last question that I posted here had to do with what I thought were erratic numbers. My last four readings were as follows, with the first number being t-cells and the second being viral load: 318/5500, 524/24000, 564/8800 and my last reading being 448/1142. My doctor is pleased with the viral load and to say the least I was shocked. I can account for my t-cell drop due to a mild cold and stress related factors including the time of day and a different lab being used, but my declining viral load has me even more confused. My doctor even hinted around the fact that I may be a LTNP (long term non-progressor) What is your assessment? I hope to prolong meds until something better comes along and it looks like it may just happen.

Response from Dr. Cohen

It may be that you will be a long term slow or non-progressor.

What this means is that the tug of war between your HIV and your immune system so far is in your favor - meaning the viral load is low enough so that our immune system can keep churning out cells as fast as they are destroyed. Since unfortunately, even with a viral load of 1142, there is some T cell loss going on. But at a rate that we generally cope well with. For years. And years.

As for the variability - it is clear that while most readings you have are bouncing around, this most recent one is lower still. However, if we instead assume that the reading of 24 thousand was an unusually high reading, perhaps provoked by a transient viral illness or other factors, then all of your readings are about 4-5 thousand with the expected range of bounce. An easy rule of thumb to remember is that viral loads can bounce by a factor of two - in other words, if your average is about 4 thousand, then readings between 2 thousand and 8 thousand are not a surprise. And that seems to apply here - if there was some temporary reason for that one higher reading. And we do see some temporary rises with provocation such as a herpes outbreak, a vaccination, or transient illness.

T cells bounce around even more - but again, if you accept a bounce of about 100 cells in this range, then almost all of yours are about 450 plus or minus a hundred.

And both of these are great readings in terms of slow progression. Does this mean it will stay like this forever?? Well, it certainly means you can safely defer meds for now while monitoring perhaps 2-4 times per year to ensure you continue in this way, and then start when you feel the time is right.

Whenever that is.

good luck.



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