CD4 Rise, Percentage Decline

Question

Dr. Holodniy,

I am 40 years old and became aware of my HIV positive status in early September 2003 having tested negative exactly 1 year earlier. So far the labs reveal the following results; September CD4/483/28 VL/163,000, October CD4/485/26 VL/213,000, November CD4/597/23 VL/259,000. I am unsure of when my seroconversion happened. At this point is the decline in percentage significant enough to warrant treatment or can I afford to wait a little longer to see if it rises? I am pleased to see the cd4 count rising, but wonder if it means anything at all against the dropping percentage. Your perspective is very much appreciated. Thank you.

Answer

Although your CD4 count and percentage would be considered quite good, the trend down in CD4 percentage in the face of such a high viral load, warrants close watching. Since your infection is less than a year old, and we don't know exactly when infection took place, there is the possibility that you are still in the acute infection period to explain the high viral load. Thus, the viral load could decline significantly over the next few months or if infection has already been clearly established, then the viral load will be staying this high. You don't need to start treatment right away, but if the trend in CD4 percentage, in the presence of such a high viral load continues, you will need to start sooner rather than later.