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CD4 response to HAART in older people
Jan 21, 2002

Dr. Cohen Several times recently you and the other doctors have commented that CD4 recovery is slow and less than perfect in older people. I would just like to put in a word of encouragement for those in that condition. I am 63, male, under HAART for five years (currently Trizivir) beginning treatment in '97 with a VL of 288K and a CD4 of 62, and very ill with PCP and dementia. It took four months for my VL to become undetectable and six months for my CD4 to rise above 200, but since that time I have maintained >50 with CD4 around 360, 22. Those numbers aren't great, but they have been adequate to keep me at work, feeling fairly good some of the time, and they are quite welcome given the alternative. I tried IL-2 in a study (injections daily for 6 months), which only caused my CD4 to bounce around a bit, with a lot of inconvenience and no permanent benefit. I exercise, take lots of vitamins, try to keep my stress level low --and I look neither very old nor sick, thank goodness.

SO, my advice to other older people would be to hang in there, take your medicine, watch your lifestyle as well as your numbers, --and give thanks that you are still among the living.

Response from Dr. Cohen

Great to hear and thanks.

While we have commented on here that age does make it more difficult to regrow these cells, your story is a reminder that some do just fine... even with higher odds. And that is worth noting - since these generalization of Cd4 increases are not meant to imply that they won't come back -it is important to note that for many, then can and do return to healthy levels.

You mention a good count in the Cd4 cells and a low but detectable viral load. (Assuming you meant that >50 is above 50 copies, not below 50?? - but people I certainly don't know enough about your specifics in terms of meds in the past and options for now... but one of our debates is what to offer those who are in this circumstance of low detectable viral loads. Since over time, the odds are good that HIV will just increase the number of mutations in its genetic code - increasing its ability to some day grow more than it is now. And, we fear, to eventually reverse the improvements you've had to the counts. So there are discussions about what we can do to "intensify" regimens such as this. And there are newer options in terms of what we've learned about this to consider. Such as the possible role for the recently approved (in the US) medication tenofovir for example in this circumstance. No dogma here -there is considerable debate. But at least something to consider if you indeed meant above 50. Of course if you meant below 50 copies..... never mind.

As for a count of 360 - this is fine - not the highest we can get to - but plenty enough to protect you from most anything - and that is after the point of all this.

And finally - the role of IL2 is an ongoing discussion since some have the experience that you did, while others have dramatic increases. And in time we'll have a better sense of what to do with that option.

Again, thx for the reminder that many older people can do great.



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