Ive had HIV since 1982 and fortunately have never had an opportunistic infection. Ive been on a few drug regimens, largely to keep up with new clinical recommendation. Ive never had a viral breakthrough due to drug resistance. My viral load has rarely gone above 400. Yet, I never get a CD4 boost from my medications. MY CD4s started dropping in the mid-1990s and have hovered around 100 for several years now. I have 3 questions: 1) Why dont my meds increase my CD4 count? 2) How well supported is the theory that in long-term survivors, the virus has infected the myeloid stem cells in the bone marrow and inhibit the replenishment of the CD4 population? 3) Whats the clinical outlook for someone like me? Thanks for providing a forum for these questions.

All great questions. You don't indicate what your lowest CD4 count was prior to being on treatment, but in some folks who started when their CD4 counts were say well below 50, they may have lost sufficient numbers of CD4 clones that they can never be replenished, despite effective therapy. Although there is some data to indicate that stem cells are infected, can be infected, how many and what the long term consequences of this would be are largely unknown. Time is on your side. Despite having low CD4 counts (which does still put you at risk of OIs), there are a subgroup of folks like you that continue to do well. I would be curious to know what your CD8 count is and how elevated. My guess is that you have a good CD8-cytotoxic t cell response against the virus. If your CD8 count is also significantly depleted than you definitely have experienced a big hit to your myeloid precursors, in that the cells just aren't being made.