What’s in store for you if after starting HAART, your viral load goes down but your CD4 cells don’t rise, or your CD4s rise but your viral load doesn’t go down? New research suggests that when the two key measures of response to therapy are discordant, it’s the cells that may hold the crystal ball. In a Frankfurt study of 965 HIVers on HAART, one out of five had a good viral load response (a drop of greater than one log, or 90 percent) but no CD4 response (an increase of greater than 50 cells) after six months. During follow-up (23 months, on average), those who had a poor or no CD4 response—regardless of whether viral load significantly decreased—got sick or died faster than those whose CD4s improved along with their viral loads. In between were those whose CD4s went up but whose viral loads had a poor or no response. Bottom line: The CD4 count is what counts.
June 1, 2000 • By Lark Lands, PhD