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3-year trends, cd4+ stable and cd4+% declining

Jul 8, 2012

Hi Dr. Holodniy,

I saw another version of this question, but the time frame was significantly shorter and the variation was within expected ranges. I have not started medication and would like another opinion on the matter. Fitting a linear trendline to my lab results over 3 years (14 points), I see the following values at either end of the trendline:

My absolute CD4+ has been stable, or even slightly increased from 700 in 2009 to 800 in 2012. Meanwhile, CD4+% has been declining from ~29% in 2009 to ~22% in 2012. Absolute CD8+ has increased from 1000 (45%) to just over 2000 (60%) in this same period, and CD4+/CD8+ has in turn decreased from about 60% to 35%.

My viral load has decreased during these three years, from 2000 to 700, on the trendline.

I have been told I do not need to begin medication at this time. I am concerned about the CD4+% decrease and increasing CD8+% however. My two questions then, are:

(1) Assuming a simple linear trendline is valid for our purposes in reporting actual trends in these data, and assuming I continue to control my viral load well and absolute CD4+ remains stable, is there a point at which you would recommend treatment based on declining CD4+% and/or declining CD4+/CD8+ ratio?

(2) Have you come across any interesting journal articles in recent publication relating to this (affects of CD8+ levels and immune activation on long-term or short-term health), that you recommend for someone? I am lucky enough to have good journal access.

Thanks so much for your time and consideration.

Response from Dr. Holodniy

1. I am concerned about the trend in CD4% decline. If it truly is approaching 20%, then regardless of the absolute number, you are losing CD4 cells. Despite your viral load being detectable and low, I think you are losing cells and HIV treatment would be indicated, even with a low viral and your stable CD4 count > 500.

2. Not sure what you are looking for, but check out this very current review on CD8 cells: McDermott AB, Koup RA. CD8+ T cells in preventing HIV infection and disease. AIDS 2012 Jun 19;26(10):1281-92.

Blood Work Ratios, etc
should I take 2nd HIV test?

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