How soon to start ARV?
Posted: May 12, 2007
QUESTION:
Patient with a newly diagnosed in January 2007, presented with CD4 of 480 at the time of diagnosis and viral load of 1.5 million. 2 weeks later, viral load was 330. Both revealed high CD8 counts with a CD4 percentage of 8%. Infection was most likely in November.
Repeat CD4 in March was 310 and viral load 1 million with a CD4 percentage of 12. Correct me if I'm wrong but CD4 counts tend to drop during acute infection and climbs up a little after a certain period. Do you think that CD4 is likely to climb back up in this instance or should I just start treatment now? How low does the CD4 normally go down during acute infection?
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RESPONSE FROM: 
The CD4% is the answer. It went down initally but has rebounded from 8% to 12%. So, as you point out, the count fell dring probable recent infection and has not come up. However, the persistently very high viral load is a major concern.
You can check the numbers once again, but I suspect this patient will need to start HIV therapy. Check a genotype if you have not already and if the repeat numbers are similar to the last set, I would start HAART.
DW
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