Last summer I had a patient hospitalized with what turned out to be pneumocystis pneumonia. He had been stable for years with suppressed HIV RNA on treatment, and CD4 several years ago was in the 300s before we stopped tracking it. During hospitalization his CD4 was ~80 and HIV RNA still undetectable.
He is in his 70s, smoker, alcoholic, COPD, frailty.
After discharge I changed nothing except to add SXT prophylaxis. Oh and he had lost 20 lb with his illness so started on HGH which has been helpful.
CD4 is back up into the 300s. I don't know why his CD4 dropped and precipitated an OI but it was a bit of a sobering experience.
------------------------------
Peter Shalit
Dr. Shalit's Office
Seattle WA
------------------------------
Original Message:
Sent: 04-20-2021 04:06
From: Samuel Samalin
Subject: CD4 Drop in Virally Suppressed Patients
I had TWO patients yesterday whose CD4 dropped from 1400 to 320 and from 700 to 320. They are both also undetectable viral load. Does any have any explanations for this?
------------------------------
Samuel Samalin
Los Angeles CA
------------------------------