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Can't get my t-cells up

Oct 28, 2012

Hello Dr. Holodnly. I am very frustrated and concerned. I was diagnosed 6 years ago -- at the time of diagnosis, my CD4 count was only 109. I immediately went on Sustiva and Truvada, and then when Atripla became available, I switched to Atripla. I am very diligent with my medication. My viral load has remained undetectable since I started treatment, but my CD4's rose to somewhere between 225 and 325 after the first year, but have stayed there. They have not gotten any higher. I just got the results from my latest tests today. Viral load "<75" (which I was told means undetectable -- is this correct?) But my tcells today were only 226. (CD4: 226; CD3: 775; CD8: 547; CD4%: 18.0) (Three months ago, my tcells were 325. But they seem to bounce back and forth between 225 and 325 over the past few years.) My doctor tells me I am doing well, and my numbers are "stable." I am concerned because I cannot get my CD4 count higher. In the meantime, I remain very healthy, no infections, not even the cold or the flu (when everybody around has them!) I am quite concerned, and almost depressed about this. Should I be looking at a different medication? Should I be looking for a different doctor. (I am in San Francisco, where there is no shortage of great HIV docs, although I am going to a very well-respected practice.) What does this lack-luster performance of my t-cells mean for my overall prognosis, and my potential longevity? Why am I not responding better, i.e. I remain undetectable, but I am not responding in terms of CD4 increase? I ask my doctor these questions, and he tells me not to stress out and not to worry. Obviously, I am stressing out, and I am worrying -- which I realize is not helpful to my situation. Is there any other medication which will help? (I take Selenium, but not sure how much good that has done.) Any answers will be hugely appreciated.

Response from Dr. Holodniy

Unfortunately, you belong to a group of people that are also in this situation. They have undetectable viral load levels (yes < 75 is undetectable for that assay), yet they can't raise their CD4 count any further. You increased your CD4 count by an average of 150, which is about the expected increase for starting HIV meds. The lower your CD4 count is when starting HIV treatment, the longer it takes to increase and the less likely you would get to a normal level (500-1500). Given that it has been 6 years, you are likely not to get much additional increase. In your case, all your t cells are decreased, both your CD4 and CD8 cells, which indicates you had significant loss in your bone marrow with minimal recovery. Some people have tried changing HIV regimens with mixed results. You are clearly in a better place then if you were not taking HIV meds. I wish I had a better answer for you.

should HAART have been started.
more than a blip in VL?

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