Dear Dr. Holodniy, I'm a 29 yo male and I was infected in jan'08. I gave you my lab results twice before, I just got the latest results and the trend does not look so great. I wanted to get your opinion on this really fast progression. Feb'08: cd4:555,vl:108000 March'08: cd4:410,vl:86000 July'08:cd4:361, vl results not yet ready. It's been less than a year since the initial infection but I'm at the treatment border already. My doctor says we should repeat the test in 2 months and if the decline in cd4 continues we should start treatment. I'm really confused and also panicked. Is this really fast disease progression? I expected to go on for several years without medicines. Does that mean I have a reaaly aggressive strain of the virus and if so how would that affect the response to treatment? How commonly do you see this kind of fast progression? Thanks for your support. With best wishes.

I agree the trend indicates a downward CD4 slope, with a relatively high viral load. You don't indicate what your CD4% is (a more stable number over time). Assuming that it has also declined by 3-5%, then the absolute CD4 number decline is real. Yes, the strain of virus could be affecting what is going on. Yes, we certainly do see this kind of slide in CD4 count with recent infections. I would recommend getting a resistance test before starting any treatment. Given the recent infection, transmission of HIV drug resistant virus is possible and you want to pick the best drugs up front.