continuing discordant response
Posted: Oct 17, 2006
QUESTION:
in a patient diagnosed 10 months ago, initial readings of CD4 :49, CD% 8, VL 128,000
after 6 months on kaletra,tenofivir,lamivudine patient was switched to kivexa (ziagen) yet latest readings show that although VL has remained low ( currently 70 after 6 months undetectable) CD4 count continues to fluctuate at low levels ( currently 154 despite high of 177 reached almost 9 months ago )and CD % is at 9.
due to latest research showing high risk of disease progression and death in such discordant response to HAART, is there any additional treatment recommended to stimulate CD4 production ? IL-2 has been advised against by local health authority as risky and unproven yet is standard practice in France for cell counts under 200 after 1 year on HAART.
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RESPONSE FROM: 
I am unaware of anything else you can do except continue HIV therapy and hope that the CD4 cell count will continue to rise. The patient has had a3-4 fold increase in CD4 cells, which is encouraging.
Years of study have failed to find a role for IL-2 in HIV disease. In the US, this agent is not used to increase CD4 cell count in those with a lackluster immune response to HIV therapy. There are risks of IL-2 (including increased viral replication).
DW
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