From Stage C3 to Where?

Question

I am great fan of your forum. You always give a clear and straight answer to what it's been asked, and you are always optimistic and encouraging, which is something badly needed when dealing with HIV infection. My question this time is the following: Being diagnosed with stage C3 HIV infection and a VL>1,000,000, and being thought of as a fast progressor (infection could have ocurred at the most only 5 years prior), is my prognosis clearly worse than others? I am currently undetectable, with a CD4 of about 500 (though with a low percentage still). I just think of things like starting off with a much bigger viral reservoir and, therefore, having a higher likelihood to develop resistances or AIDS-related cancers. Thank you very much as usual

Answer

Hello and thanks for your kind words and questions.

While you were clearly diagnosed with advanced immunosuppression and clinical disease, the rate of progression or pre-treatment viral load doesn't seem to correlate as much with on-treatment prognosis as your nadir (lowest ever) CD4 count.

That you've clearly responded quickly to treatment is suggestive of your body's ability to recover- not just by CD4 counts, but in other, more difficult to measure ways. With an undetectable viral load and normal range CD4, I'd place your long-term prognosis in the excellent category. For my patients like you, I pivot my care focus from CD4 numbers to aggressive primary care and preventive medicine- things like cancer prevention (tobacco reduction/cessation are tops on my list) and cancer screening (routine Pap, colonoscopy, breast cancer screenings, for example), vaccinations (hepatitis, pneumonia, influenza and for my sexually active gay patients, meningitis).

Hope that helps, and be well. BY