everything crashing down
Posted: Jun 24, 2006
QUESTION:
diagnosed in dec 2005 with advanced stage of disease cd4: 49, 8% and VL 128,000. 6 weeks later and VL was undetectable and CD4 rose to 177 with 12 %.
6 months later and VL remains undetectable but cd4 has steadily fallen to 98 and 4.9 % , lower even than before treatment !
40 years old, diabetic for 30 years on injections and regime is kaletra, viread and epivir, 100 % adherence, no OIs or other infections or kidney disease.
i have read three other cases like this, is anyone studying the relationship between kaletra reducing VL to zero and destroying the immune system at the same time ? what else could be causing this ?
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RESPONSE FROM: 
Thanks for your post.
There are sporadic case reports of such discordant responses-- viral load undetectable but CD4s decreasing. Fortunately, such cases are quite rare.
Some have postulated an effect of RT inhibitors (especially ddI); we've seen a similar case on lopinavir/ritonavir, tenofovir and 3TC-- like yours, in whom the CD4 rose after substitution of tenofovir with abacavir.
Let us know how you manage your patient and the outcomes. Best, BY
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