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Do some people have lower cd4 counts naturally?
Nov 3, 2001

Thank you first of all for all the information you provide. It is an invaluable source of information to those of us who are infected.

I have a question that I cannot seem to get a good answer for. I was infected in 1986. At the time, there were no viral load tests, but my cd4 was at around 500. It remained at around that for the next couple of times I had it tested throughout 1987. I pretty much avoided the doctors until late 1999 when I finally got sick (community aquired pneumonia). At the time my cd4 was at 22. I started treatment and my cd4 count a year and a half later had only risen to about 150. I finally resorted to using IL-2 to increase my counts and after two cycles got to 250. My question is whether or not some people's immune systems function properly with lower absolute cd4 counts than others. For example could a person with a cd4 count of 150 possibly have the functional immunity of someone with a higher count? Obviously that kind of count indicates a fairly advanced level of immune damage, but I guess I am wondering if the natural variability in cd4 counts from person to person might result in different levels of immune function at different counts. I certainly have no intention of basing treatment decisions (especially prophylaxis) on that theory. What it would help me with is the possibility that I might not see the same kind of dramatic increases in cd4 counts that others have because I never had a cd4 count that was over 500 to begin with.

Response from Dr. Holodniy

There have not been any detailed studies to answer this question. Most of what has been published is epidemiology and not studies of the functionality of T cells. However many of us have patients in our clinics that have very low CD4 counts (<100), and who have never been ill. Some of this is related to better prophylaxis in later years. Some of it though may be related to their immune systems, since many of these folks have very low levels of virus (with or without therapy), indicating some better containment of viral replication. In other words, a person with a CD4 count of 75 on no treament and a viral load of 5,000, may be in better shape than a person with 350 CD4 cells and a viral load of 250,000 off treatment. MH



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