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Labs, and genetics, and aging, oh my!

Oct 20, 2013

Hi Doctor Holodniy,

Its the analogy guy again! Thank you for answering my questions last week that made my day! So, speaking of aging with HIV, I did actually have a couple of questions that have been lingering in the back of my mind regarding lab results in relation to early aging and the genetic factor.

Ill start off with labsIm hoping Ive had a good response?

*Initial labs, 09/09/12, 22 years old: VL: Just above 2,000,000 (Picture the shower scene in Psycho: Those 2 commas were like Norman Bates and the knife, and I felt like Janet Leighwell, the shock made me look more like Marty Feldman in Young Frankenstein, but Janet Leigh still would have been proud of the scream I let out!) CD4: 325 CD4%: 17 I was then put on Atripla. Now cue the birds!

*2nd labs, 10/01/12 VL: 9,240 CD4: 617 CD4%: 25.2

*3rd labs, 01/03/2013 VL: <20 CD4: 733 CD4%: 32.6

*4th labs, 04/10/2013 VL: <20 CD4: 750 CD4%: 31.4

*5th labs, 07/15/2013 VL: <20 CD4: 743 CD4%: 32.5

*Current, as of 10/16/2013, 23 years old: VL: <20 CD4: 767 CD4%: 33.8

Since it's only been a year, I've been cautiously optimistic, but Im hoping my CD4 counts and CD4% will continue to increase. I think Chicago's "Questions 67 & 68" captures the anxiety of getting labs results back when they say, "I'd like to know, can you tell me? Please don't tell me!" As for the meds and lifestyle: I strictly follow my med regiment, havent missed any dosages, eat healthy, and exercise daily.

Anyway, I recently read your article/interview about accelerated aging seen in patients with HIV and was curious as to what the labs of those patients were like. Was accelerated aging seen in patients regardless of their viral load or CD4 counts and CD4%? Was early aging seen in particular age groups? Also, as mentioned in the article, there isnt a great understanding as to how much of that acceleration of early aging may be due to genetic and environmental factors in addition to having HIV infection. Has there been any sort of advancement in getting a better understanding as to how those factors may play a role in accelerating early aging in individuals with HIV since that article was written? Coming from a family that has had cardiovascular problems, a variety of different cancers, and type II diabetes (I couldnt have asked for better genetics, really!) that developed in individuals in their mid 50s, Im concerned that having HIV will not only increase my likelihood of developing any of those conditions but will make me do so at an even earlier age than family did.

I hope that made sense. Sorry if that was long-winded!

Thanks again!

Response from Dr. Holodniy

You have had a fabulous response to HIV treatment. Given that your CD4 count and percent are well within the normal range, you may not see them increase that much more. Underlying genetics and lifestyle to play a big role in who is affected by various chronic medical conditions like heart and lung disease and diabetes. Although accelerated aging at the cellular level has been seen in people with HIV infection the earlier and more sustained the virus is controlled the better these processes can be arrested. We have snapshots of these issues and not a lot of long term follow-up using the sophisticated tests necessary to study these questions. Of course lifestyle issues (smoking, recreational drug use, excessive alcohol consumption, obesity, etc) also accelerate these processes as well, so anything that can be done to improve ones lifestyle will decrease the risk of accelerated aging.

HIV and asymptomatic raised alkaline phosphatase level
Can CD4% increase further after 1 year HAART treatment

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