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Why the Plateau?
Feb 16, 2003

Dear Dr. Mark,

I have read quite a bit in your forum about CD4 plateaus and PARTIAL restoration of the immune system.

My question is: Is there some scientific explanation for why people who have had very low CD4 counts do not make a full recovery? Or is it just a phenomenon that has been observed?

(My CD4 count is still mid-200s after four years HAART, by the way - I'm not that worried but it puzzles me.)

Thanking you for your help.

Mark

Response from Dr. Holodniy

I don't have a very good answer for this. I suspect it relates to how low your CD4 count was when treatment was started. People with profound CD4 loss have lost a significant number of t cell clones. Each clone has the memory for a particular foreign protein or antigen, and when recognized this cell triggers the immune system to make millions of copies of this cell in response to the invader. In addition, we need to be able to respond to new foreign antigens so the bone marrow must supply precursor cells (like stem cells) and the thymus must process (create mature new clones) in order for the immune system to respond. I suspect there are irreversible defects in this system, or perhaps it takes many years to reconfigure the immune system.



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