Thank you for your post.
Your's is indeed an unusual case in some aspects.
The first major area that is relevant is that while the vast majority of patients have detectable virus following acute infection, some do not. A further subset of patients with low, or undectectable virus (off treatment) can have CD4 count declines- indicating that low-level viral replication is still causing immune damage.
In your patient's case, there are some areas of questions-- first, I would think that repeating the lab tests would be in order. Since the patient is now on Triomune (d4T/3TC/NVP), I would generally expect CD4s to be increasing. Is the patient's CD4% improving or worsening?
In the presence of an adherent patient with declining CD4, I'm concerned about the possibility of treatment failure-- either because of transmitted drug resistance (not uncommon, even in resource-limited settings) or early evidence of drug toxicity.
Best of luck; write back with any follow up. BY
