|AIDS diagnosis (HIV VERSUS AIDS DIAGNOSIS DEFINITION)
Mar 12, 2008
12 months ago I was diagnosed with AIDS as a result of an NHL diagnosis. My CD4 was 40 and VL was 750,000. After 12 mos, my CD4 is 274, VL is <40 (new testing has triggered and no longer undetectable) I'm on Atripla and take 100-200mg of CQ10 daily. I've also beat the NHL for now too. Is this a good/normal response rate on the CD4 side? Am I still considered to have an AIDS diagnosis? Does one ever go from AIDS to HIV? How high can I expect my CD4 to go?
Response from Dr. Frascino
Congratulations on your improved health status. Regarding the AIDS diagnosis, that remains even if your CD4 count rises above the 200 mark. (See below.) As far as how much immune reconstitution (rise in CD4 count) you can expect on effective antiretroviral therapy, the answer is no one knows. There are far too many confounding variables to predict. These include variables related to the virus (viral strain, viral resistance, etc.) and variables related to the host (genetic susceptibility to certain viruses, immune integrity, concurrent opportunistic infections or malignancies, adherence to antiretroviral regimen, etc.). The important treatment goal is to keep your HIV plasma viral load suppressed to undetectable levels with antiretroviral therapy. This allows the greatest opportunity for immune reconstitution (rise in CD4 cells). At this point I believe you have just cause to be optimistic!
HIV vs AIDS??? (DEFINITION HIV VERSUS AIDS) Oct 27, 2007
BIG question. I have been getting conflicting info on this. What is the difference between HIV and AIDS? I thought (think) there is a huge difference between the two.
Response from Dr. Frascino
No, actually there is not a huge difference. Everyone with AIDS (Acquire Immune Deficiency Syndrome) is HIV positive (Human Immunodeficiency Virus positive). AIDS is diagnosed when an HIV-positive person's immune system deteriorates to a specific point (CD4 count of 200 or CD4% of 14%) or when he/she acquires certain opportunistic infections or malignancies. I've addressed this topic numerous times before. (Check the archives!) I'll reprint some basic information from the archives below.
FULL BLOWN AIDS/please answer Jul 17, 2007
what does full blown aids mean?Is there a number that states that.I have 47 tcell and 713,000 copies of hiv virus in my body.Is that considered full blown???please answer.thanks
Response from Dr. Frascino
HIV disease is termed AIDS when the immune system has deteriorated to a specific point. The definition of that specific point was made by the CDC for surveillance purposes (so that the number of cases could be determined). At the time the definition was created, HIV disease itself was not a "reportable" condition. Consequently we had difficulty tracking the epidemic or how quickly it was spreading. The CDC then came up with the definition of AIDS and made it a reportable condition. Cases were then reported to the CDC and counted for epidemiological purposes. Since then, new laws have been passed and now HIV alone is also a reportable condition.
An AIDS diagnosis is made if the CD4 count falls below 200 or if the CD4% is less than 14%. Also, if an HIV-positive person develops certain specific "opportunistic infections or malignancies," the diagnosis of AIDS is also confirmed. This list includes Pneumocystis pneumonia, Kaposi's sarcoma and cytomegalovirus, among others. You would have AIDS because your CD4 count is less than 200.
Finally, I should mention we don't use the term "full blown AIDS" anymore, mainly because there is no such thing as "partially blown AIDS". I'll reprint some information from the archives below.
t-cell count determines hiv or aids diagnosis? Jul 21, 2006
I remember my doctor at the time told me if my t-cell count dropped below 200, I would be considered to have Aids, but until then I am HIV+. Is this true? My t-cell count has dropped as low as 48, but is currently over 300. Can a person go from Hiv+ to having Aids to being considered Hiv+ again? I find people, being the public are more accepting of an hiv diagnosis rather than an aids diagnosis.
I know it's a silly question, but one I have thought about for some time now.
Response from Dr. Frascino
I'll repost below a question and response from the archives that addresses this concern. In brief, once a diagnosis of AIDS has been made, it is not rescinded, even if the CD4 count rebounds or the AIDS-defining opportunistic infection is completely cleared. I should also mention we no longer use the terminology "full-blown AIDS", as there is not such thing as "partially blown AIDS".
Your question is not silly. That 25 years into the pandemic "the public is more accepting of an HIV diagnosis than and AIDS diagnosis" is what's really silly! It shows we still have a long way to go in educating John Q. Public about HIV/AIDS. Unfortunately that education process is made all the more difficult by our current administration's backwards policy on sex education and HIV prevention together with the Republicans in Congress bowing to pressure from religious extremists. Let's hope this situation will be at least partially resolved with the upcoming mid-term elections.
AIDS OR NOT, THATS THE QUESTION Jun 12, 2005
On 5/24/05 the posted question about AIDS classification leaves me puzzled. In 1997 ZI was diagnosed with AIDS. My cd4 was 45 and I had several opportunistic infections. At that time I was given an full blown AIDS diagnosis. Four years later my cd4 was over 600, my viral load undetectable and my diagnosis was changed to HIV+. At that time my doctor was one of the tops in the field of AIDS research and treatment. I queried him about the change in diagnosis and he said CDC guideline had changed. Your answer on 5/24/05 leaves me wondering, who is right, who is wrong, and why the difference?
Response from Dr. Frascino
The CDC has not changed their HIV/AIDS diagnosis/classification criteria. So I guess that makes me right, him wrong and overall really not much difference as I explained in the response I previously posted. (Reprinted below.)
AIDS classification question Posted: May 24, 2005
Hi Dr. Bob,
I wrote to you regarding a question in the "Am I Infected?" forum.. and I'm not sure if this is the right place for my question -- but I always take consolation in the manner that you interact with people, so I'm hoping that you'd be able to answer this question -- which, arguably, could be placed elsewhere.
My friend's CD4 count, sadly, is in the high 90s. It's my understanding that this classifies him as having AIDS (I think the number is 200?) I believe he's been HIV+ for between 3-5 years. Is it possible, at this lowered state, that he would be able to increase this count/reduce the VL to a level that would not be considered AIDS? (I'm sorry for the crude phrasing of this question; but I'm not as educated in this topic as I'd like to be) It breaks my heart that I can't help him more -- his paticular strain has become resistant to his meds and he is going to start a sort of "trial" medication in the next week or so, which hopefully will help.
I guess my question is: is there a chance that with medication, lots of care and support, that he could recover from the low CD4/VL count? It's times like this I wish I had an M.D., too, and could do something medically instead of just emotionally. This message is quite somber, for which I apologize -- but this is my first friend who is HIV+, it's tough to be strong when I see him not doing so well -- and I just want to be there for him in any way possible.
Any advice or insight you have (despite perhaps the incorrect forum classification) would truly be appreciated.
Stay well, Dr. Bob. You're an inspiration.
Dr. Bob's response:
Anyone with either an AIDS indicator condition or a CD4 cell count of less than 200 has a diagnosis of full blown AIDS. However, the relevance of this diagnosis is more historical and epidemiological than clinical. HIV disease is a spectrum that goes from mild, asymptomatic disease to severe, symptomatic disease. There are folks with a full-blown AIDS diagnosis, who at the present time are feeling quite well, and likewise, there are people who do not "qualify" for the AIDS diagnosis, who are very symptomatic and ill. The CDC classification of full blown AIDS is used as a criterion for tracking the epidemic and allocating federal funds. Reporting requirements for HIV infection (not full blown AIDS) vary from state to state. However all cases of AIDS must, by law, be reported to the health department. Next, is there a chance that with the proper treatment your friend could significantly increase his CD4 count (above 200) and reduce his viral load to undetectable? Yes! If his trial medications can suppress HIV viral replication, his CD4 count will rebound. Working closely with a competent and compassionate HIV specialist is crucial. Sometimes getting a second opinion form another HIV specialist can be helpful, if things are not going well.
If your friend's CD4 count does increase above 200, will he still have a full-blown AIDS diagnosis? Yes, once this diagnosis of AIDS is made, it is not negated by subsequent developments, even if treatment produces a remarkable degree of immune reconstitution. However, do remember it's your friend's health and immune status that are important, not a "diagnosis" made primarily for surveillance purposes.
Finally, I should point out: don't wish to be an M.D. to help your friend. Chances are he'll have more than enough doctors involved in his care. What most HIV folks need are friends. A true friend is often more potent, soothing and healing than any medical intervention.
Good luck to both you and your friend.
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