Question
What is the outlook for my girlfriend who has a CD4 count of 101?
16 May 2007. Related: All topics, CD4 and viral load, Side effects, Starting treatment.
Hello again
Things are a bit difficult in my country (India) as regards getting medical tests and treatment for HIV. The main problem is the lack of discreetness and privacy.
Anyway, my hope till now was that my girlfriend would have a good CD4 count. But she has got a very low count of 101 cells/mm3.
The surprising thing is that she is still well and has no symptoms. I want to start her to think about treatment now.
Until now you have answered my questions on hiv treatment with my assumption that she would have a good CD4. What is her prognosis now? She has never had any treatment.
Thanks for all your support and encouragement.
Answer
Hi again
All treatment guidelines recommend that your girlfriend should start HIV treatment.
Is is great that she has not had any symptoms so far, but this is really just good luck. She is more at risk of infections while her CD4 count is under 200 cells/mm3.
Although her CD4 count is low now it is still not too bad, but you don;t want to leave starting treatment nuch longer. HIV treatment should bring her viral load down, and this will let her CD4 count get stronger again. Even though she is starting with a lower count, she should still have a good response to treatment.
This should mean that her long-term outlook (her ‘prognosis’) will be as good as if she had started with a CD4 count that was higher.
First-line treatment in India is likely to be with nevirapine + d4T + 3TC. This is usually in a fixed-dose combination where all 3 drugs are in one pill that you take every 12 hours. For the first 2 weeks you need to use a lower nevirapine dose (200mg once a day rather than 200mg twice a day).
If your girlfriend has any side effects, then switching one of the drugs is important. One of the main side effects of d4T can be neuropathy – where tingling or numbness in the toes or finger can lead to more serious nerve damage. This should reverse if treatment is switched early.
See info on this in the i-Base guide to side effects
Good luck to you both
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