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Lab tests to determine qualitative issue about CD4's

Apr 11, 2004

Dear Dr. Holodniy, I have a normal CD4 count >700 and a percentage >40, which I'm told is good. And my VL has never exceeded 5,000 and is often undetectable. Infected 26 months ago.

Still am quite unwell from multiple viral type symptoms. More recently, I also developed angular cheilitis and was told that this can signify a qualitative problem with my CD4 cells. So, the CD4's were tested...cultured with pokeweed mitogen, PHA, Con A, candida and I think environmental antigens. The CD4's did what they were supposed to in those tests. Does that totally rule out a qualitative issue or does the fact that the CD4's performed well against mitogens and antigens still leave room for the possibility that they do not perform well against pathogens such as HIV virus? What other Lab tests can/need be done to ensure that there's no qualitative issue with the CD4's and their capacity to handle the HIV virus? With low to undetectable VL's, these multiple,now chronic, symptoms are weird and I thought that maybe qualitative problems with the T cells might explain this - if so, it could make sense to go on therapy.

Does it make sense that qualitative CD4 problems could explain multiple symptoms despite normal CD4 numbers and, if it does, can you extrapolate from CD4 tests with mitogens and antigens to how the CD4's would behave with viruses such as HIV? Any other tests you would recommend to fully address this issue? (maybe culturing my CD4's with HIV virus and seeing how they would cope?...where could one have that done?).

Thanks so much for your advice and help. Sincerely.

Response from Dr. Holodniy

Immune function testing is a bit like the wild west. There is no standardization of these tests, so you get what you pay for. Most of what your cells were tested against are nonspecific immune system stimulants. Antigens like candida, tetanus or mumps are commonly used to test "recall", in other words your immune system memory to things it has been exposed to and should recognize, either because of natural infection or vaccine exposure. Testing for HIV specific immune function is tricky business in the best of research labs. It is not offered as a commercial test for good reason. I would have expected your immune system to react positively to those stimuli given your CD4 count. There could in fact be subtle defects lurking underneath, which cannot be adquately measured and yes this could be contributing to your symptoms. In the not too distant past, we would start people on HIV treatment. Many of these folks had their symptoms go away, which indicated it was probably the virus that was causing them. Most experts today would look at your numbers and say not to start treatment. However, a trial good answer the question for you.

CD4 Will Never Increase?
How do these T cell subsets compare with the norm?

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