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Ask the Experts about Understanding Your Labs
High hyperlymphocytosis CD4/%/8/VL : Start meds ?
Aug 17, 2008
Questions:
The labs shows:
- CD4% decrease
- CD4 increase
- CD8 increase
- VL almost stable, low
1) Should I start meds (CD4% almost continuously decreasing)?
2) Is Intelence, Isentress, Darunavir/r the right combo being given the resistances ? (or Truvada + Reyataz ?)
3) About the CD8: Anything to worry about ?
My doc ordered a HTLV-I test and want to investigate lymphoma or so if CD8 trend continue to increase.
What would be for you the reason of this high CD8 activation ?
Thanks a lot Doc!
Response from Dr. Holodniy
You are right to question what is going on here. thanks for providing such complete data. On the face of it, if you just looked at the viral load and CD4 count, you would think that everything is OK. I am concerned that the CD4% has continued to decline. This indicates to me that you are losing ground. On the other hand, you have a very robust CD8 count. The CD8 count does increase in most people with HIV infection as a reaction to the infection. CD8 cells and function are important in the control of HIV infection. Complicating the picture is the fact that your viral strain already has two-HIV drug class resistance. Your situation is one where there is no right answer, nor would there be a consensus opinion from experts on what to do. I would lean on the side of starting treatment and your first option listed would be an excellent choice, given the resistance profile.
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