Bacrtim and CD 4 count.

Question

Hi Doc.

I have been diagnosed Positive in Feb this year. Started immediately on Atripla and is now about 6/7 months on it. My counts were as follow: 2/2/2011 VL 10000000, CD4 - 422. 7/4/2011 VL 2088, CD 4 - 225. 5/5/2011 VL 199,CD 4 -181, I then started on Bactrim twice daily. I did another check last week and got the results today. VL 20, CD4- 242. Should I be concerned that my CD 4 is not rising at a fast enough phase? I have not been exercising the past month like I use to and got distracted with my diet on "the sweet things in life"... is this the reason the CD 4 is going up so slow or is it just me being impatient.....

Looking forward to hearing back from you doc.

Thanks n mil!

Answer

Hello.

The CD4 response (immune reconstitution) lags behind the viral load response. Your HIV plasma viral load has been steadily decreasing and now is at a very low level. Your CD4 count has just begun to increase. Exactly how much immune reconstitution (rise in CD4/CD4%) you will experience, no one knows. Your initial very high viral load of 10,000,000 indicated the virus was extremely active. This sky-high viral load accounts for your plummeting CD4 count. Now that the viral load has reached nearly undetectable levels, we can hope your CD4 count will continue its upward trajectory.

The Bactrim was added to your regimen as prophylaxis against an opportunistic infection called pneumocystis carinii pneumonia (PCP). If your CD4 counts stay above 200 (and CD4% above 14%) for three months, your primary PCP prophylaxis can be safely discontinued.

Good luck.

Dr. Bob