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CD4 DOWN, HELP
May 5, 2008
PLS DOC I HAVE BEEN POZ 4 2 YRS NOW,IWAS INGRESSED 2006 WITH PHNUMONIA AND SARCOMA KOPSI,I HAD 8 MONTH OF PENTAMIDINI EACH MONTH,AND I AM CURRENTLY TAKING TRUVADA AND KALETRA,MY CD4 HAS GONE FROM <200>250>281<250 AND THIS TIME 215 MY VIRAL LOAD IS <50 NOT CHANGED,MY DOC SAYS THAT IN SOME PPL LIKE MYSELF THIS IS NORMAL AND THAT NOT TO WORRY HAS I AM STILL STRONG AND FIT,PLS COULD U GIVE ME A SECOND OPINION ON THIS VERY WORRIED THANX
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Response from Dr. McGowan
First of all, I am sorry it took so long to reply, there has been a gap in our coverage of this forum. I hope you are still doing well.
The extent and pattern of CD4 responses to treatment (called immune reconstitution) are affected by many factors: how low the CD4 count has ever dropped ( called the CD4 nadir), the length of time having a low CD4 count, your age (CD4 recovery is slower with older age, especially over the age of 50 years), proportion of Viral load measurements that are "undetectable", the type of therapy you are on (protease inhibitors may block cell death and increase CD4 counts slightly better than non-PI regimens), and immune activation. Immune activation is a term to describe how much inflammation is going on in the body. The presence of an ongoing chronic infection, such as tuberculosis, MAI (mycobacterium avium-intracellulare), CMV or other herpes infection may slow the immune recovery. One thing to look at is the trend of your CD4%. This number reflects the balance between your CD4 and CD8 counts, if it is steadily improving it may reflect (as your suppressed viral load does) that your HIV is well controlled and that your slow CD4 recovery may be due to other factors.
Best,
Joe
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