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If HIV kills CD4 cells that present themselves, can high CD4 levels in first years of infection later result in faster progression to AIDS?

May 16, 2004

Dr. Holodniy,

I am searching for the right words, but have an important question:

It is often assumed that the more CD4 cells in a T cell subset, the better. But,in that the more CD4's that present themselves, the more for HIV to kill, could this be a wrong assumption for people who have very high CD4 levels...for example, 1,300 to 1,600.

Specifically, if someone tends to have very high CD4 levels that go way up and way down within normal range during the first couple of years of HIV infection, does that mean that the HIV virus has a greater chance of killing off more CD4 cells and the wide fluctuations corroborate this?...that in the years after the first few of infection, the fact that such an individual's immune system presented more CD4's to be infected means that they could later progress faster to AIDS? It would seem that someone who has lower, yet still normal CD4 levels, would be more stable and keep some of the immune system in reserve for later versus someone whose immune system was in overdrive and presented too many CD4 cells to be killed by HIV too soon? (Is the analogy to having too many soldiers clustered together,so that more would be killed if a bomb landed on them...versus keeping some soldiers in reserve... relevant?).

Any studies on the issues and,in any event, could you please share your thoughts whether there is logic to this?

Many thanks.

Response from Dr. Holodniy

Not alot of studies on this issue. It is usually assumed that those infected people with such high CD4 counts, usually have low or undetectable viral loads, indicating an immune system with better capability to contain viral replication. It has usually NOT been the case that people with these kinds of high CD4 counts have very high viral loads.

VL over 750000 3 month after primoinfection

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