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Chronic Immune Activation

Aug 19, 2017

Dear Dr. Holodnly, I was diagnosed almost 3 years ago with stage C HIV infection. I have slowly recovered and have plateaued with a CD4 count of around 500 (19 %-20%) and a C8 of 1400-1600. That leaves a CD4/CD8 of 0..3 ,that hasn't changed in 2 years. I have been undetectable for 2 years now. My Doc says that no-one looks at CD4/CD8 ratios anymore, but I read everywhere about chronic inflammatory states, risk of Non-AIDS related cancers and high CV risk in people like myself.

Questions: 1. What is my real risk vs other HIVers with a similar CD4 count but a normal CD4/CD8 ratio? 2. Would a low dose statin (i.e. Atorvastatin 10 mg) and a daily baby aspirin help counteract that pro-inlammatory state? 3. Besides staying healthy otherwise, anything else that could be done? Any room for improvement in the long term? 4. Does this ratio speak of a very virulent strain of HIV ( I got to stage C only 5 years after infection and my initial CD4 was 88)?

Thank you so much for your knowledge and advice

Response from Dr. Holodniy

People with markedly elevated CD8 counts (yours is not) have been found to be at risk for inflammatory issues. Unless there are definite risk factors for (elevated cholesterol, significant cardiac risk factors) addition of a statin would not generally be indicated. Unfortunately there is not much one can do but maintain healthy living habits. Hard to say whether the strain is more virulent or not. Assuming your pre-infection CD4 count was around 500 (where you are now), yes that would appear to be an accelerated decrease in CD4 count in 5 years.



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