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Undetectable VL but low CD4 counts
Aug 26, 2005
I started HAART about 12 weeks ago after a 1 month hospitilization for seizures, cause undetermined but toxoplasmosis is leading suspect. Initially I was placed on Kaletra and Truvada (along with a host of prophylactic agents targeting various OI's like CMV, PCP etc) but HAART regimen was changed apx 6-7 weeks ago to Combivir (150 mg x 2 daily) and Sustiva (800 mg x 1 daily) to ease SEVERE gastrointestinal distress. My VL has dropped to undectable using the more sensitive test (less than 20 copies), and my CD4 count has increased from 24 to 50 to 93 most recently. I am heartened by VL numbers but distressed by lack of progression in CD4 counts, although % increases have been fairly good (roughly doubling with each test). Should I re-examine my HAART meds, perhaps shifting back to Kaletra/Truvada regimen (which seems more effective from what I've read), stay the course and be patient with current meds, or look at a new regimen entirely? I am quite happy overall with my treating physician who seems quite current and well informed relative to HIV/AIDS and HAART treatments, I guess I'm looking for some affirmation or validation here to calm my nerves...
Thanks in advance for your thoughts and advice!
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Response from Dr. Luzuriaga
It sounds as if you have had a very nice virologic response to your treatment. A rise in CD4 count often lags behind the control in viral replication and it may take 6 months or more of viral suppression to see it come up. However, you mention that your % CD4 has been increasing, which is a very good sign. If you have been tolerating your new regimen well, I would recommend that you continue.
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