Question:

I have been positive since 11th Jan 1997 and on combination therapy since Oct 98,after an intially rocky start(CD4-300:Viral load 300,000).I have now got to the stage where I am undetectable at less than 50 copies and a CD4 of 1500.

I currently take Combivir and Nevirapine(1 tablet each twice a day).Also for the last 3 years I have been taking Warfarin @14 mg daily following two D.V.T.'s(1.right calf,2.behind right knee).

Warfarin dose is high due to absorption difficulties when taking AZT component of Combivir(apparently!).

Otherwise my health is stable.

My enquiry is following my last test in October 04 CD4 was 1500 and CD8 was 1214,which according to my Consultant(U.K.) is more in line with a patient who is negative.....so what do you think is going on ?......am I cured? Obviously not but strange results nonetheless.

Your thoughts please.

PS - I did have a "blip" in early 2004 where I took Sustiva at 800mg a day for about 3 months after a sudden rise in the v/load to 30 000 and a drop in CD4 to 600,next test I was back to undetectable and 900 CD4.

Answer provided by:

Daniel Lee, M. D.
Assistant Clinical Professor of Medicine
UCSD Medical Center
Owen Clinic

In regards to your numbers, I think that you have obviously done very well on your regimen. You are likely not cured, however, because if you stop your meds, likely your viral load will come back up and your CD4 cells will drop. While it is unusual to see such a good response with CD4 counts higher than CD8 cells, it can and does occur (rarely, though). A normal uninfected person usually has a CD4 to CD8 ratio of greater than 1 - meaning CD4 cells are greater than CD8 cells. In the HIV + person, we usually see the opposite or inversion of the CD4/CD8 ratio, such that this ratio is less than 1. Even after we treat with HIV meds, it is uncommon to see the ratio rise back over 1. In a small percentage (5% - my opinion) of people with HIV (usually untreated), you may see a ratio greater than 1, but these people are usually long-term nonprogressors. In these patients, doctors often wonder whether they are truly HIV+ due to this ratio being greater than 1. Hope that helps and congratulations on your numbers.

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