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Living without a thymus - should I worry?
Jan 31, 2011

Dear Dr Bob

I have been positive for about two years and been on Stocrin and Truvada for the last year. I am undetectable and my CD4 is 285.

I had Hodgkin's Lymphoma 9 years ago and has been in remission for the past 8 years. The cancer was obviously not HIV-related.

My question is. When I started ARVs my CD4 was 180 and VL 120 000. Within 10 weeks I was undetectable and my CD4 580. Then I had a flu injection that crashed my CD4 to 380 and ever since it has not been able to recover, going down to 225, up to 330 and now 285 again. My specialist advised me not to do these vaccines again since we can see that my in my specific case my immune system is reacting more hectically than expected and 'burns' itself out so-to-speak.

During my cancer treatment my thymus was removed since it was 'overtaken' by cancerous cells. Thus my HIV specialist thinks this might be the reason for my CD4 being low and thus slow recovery in terms of CD4 cells. He stated that since I don't have a thymus his expectations regarding my CD4 should be lowered and he would be happy if I can get my CD4 up to about 400. He states that it is possible since I once was able to get to 580.

I go for my cancer check-ups regularly and was given the clear a week ago. My blood counts are 100 percent and both my oncologist and HIV specialist are amazed that all my organs are functioning 100% normal, no sign of abnormality and stress due to past chemo and current ARVs.

Should I stress because I dont have a thymus? I have read up on the issue and there seems to be not much information about this issue? My specialist states that since I do have CD4s it means they are still being created, and most probably in my bone marrow, but now I am stressing where they are being matured? My glands? Spleen? or am I dependent only on old memory T Cells reproducing?

I feel like I have been coping miraculously well given my scenario. Cancer, HIV and a immune system that is dodgy from the onset. Since I have learned about the impact of the thymus I am now even more worried about my long term prognosis, thinking I might be a time-bomb waiting to happen. On the other hand I am healthy and really doing great, and like my doctor stated, the body compensates in many ways for deficiencies and my CD4 count might be lower, but I know this now and thus can compensate by taking good care of myself, do my check-ups, take my ARVs religiously and enjoy life.

Regards and THANK you so much for the great work you doing in the HIV+ community

Thymusless in South Africa

Response from Dr. Frascino


Should you stress because you don't have a thymus? No. Stressing won't make it reappear.

Your specialist is correct: CD4 T-cells can be produced in locations other than the thymus; bone marrow, for example.

As for T-cell maturation, this can occur without an adult thymus. It can occur in other lymphoid organs. Again, I agree with your doctor: the body has amazing compensatory abilities.

I absolutely agree with your plan going forward: "taking good care of myself, do my check-ups, take my ARVs religiously and ENJOY LIFE!" (I added emphasis to the last item on your list, as I feel it deserves special attention!)

Be well.

Dr. Bob

Great Test results but Feel terrible
Dosing of ATRIPLA depending on patient.

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