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Understanding the Immune System
Dec 15, 2002

I have been on HIV medicines for 3 years. My Tcell count has never been below 550 (the result of my first test). My viral load has been below 400 for all tests except for one over a year ago (where it blipped at about 500). My Tcells usually stay between 900 and 1200. Since I have no visible signs of HIV symptoms and no side effects from the medicines (except for feeling a little drowsy sometimes when I take Sustiva at 11:00PM...which may just be from being sleepy in general), I was under the impression that despite being HIV+, that my lab tasks indicate I have a normal functioning immune system. Now to the questions. On the news, they talk about the fact that with regard to the Smallpox vaccine, it should not be given to those with AIDS or those who have HIV. This implies that we are all lumped into the same category despite the individual nature of how each person handles HIV...and at what stage they are with regard to the progression of the disease. Can you please explain why someone like me would not be a good candidate for the Smallpox vaccine? Is my immune system compromised despite my fantastic lab results and consistent numbers? Are there other things I should avoid since despite my great health, I am being classified in the same category as everyone else who has HIV? Please advise or let me know if I should have asked a different forum this question. Thanks for your time.

Response from Dr. Holodniy

The CD4 count is a gross measure of immune competence. In order to understand where someone might stand with regard to HIV infection and immune competence, requires measuring the function of CD4/CD8 cells in response to HIV and other antigens. Just because someone has a good count does not mean their cells are working at 100%. It is clear that someone with AIDS and someone with your CD4 count are not in the same camp. The NIH is contemplating a study of small pox vaccination in HIV infected people with CD4 counts > 500.



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