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Thanks for your reply, and some interesting info.
Sep 11, 2004

Dear Doc, Thanks for your positive answer to my question, and your history of two of your patients similar to me. You stated that both of your patients had slow cd4 declines, and one eventually had to go on meds due to the cd4s dropping to below 300, over many years of being infected. Dont cd4s usually decline with age in normal people? Ive done much reading on the subject, and have read that uninfected people can sometimes have cd4s drop below 300 in the morning, as part of normal immune fluctuation. One interesting fact discovered about myself, is that my cd4s are VERY time of day sensitive. Aaron Diamond took them at 7:30AM and my cd4s were 350, and cd8s were 250, which really scared me, and if they were consistently taken at that time, it would have caused myself much alarm and worry. My cd4cd8 count has been taken at various times during the day and has a consistent, but different number for each hour, and the number grows higher throughout the day. But the strange fact is, my percentages remain exactly the same, and when they were taken at 8:30PM on the SAME DAY by my doctor, my cd4s were 845, and cd8s about 430. I have a fluctuation of over 500 points over the course of a day, and have no change in my percentages. It is like my immune system sleeps, when I sleep, and wakes up during the course of the day. Dr. Markowitz, said that I had no need to worry, because stable percentages are an indication of no progression. He said my body isnt detecting antigen, and my cd8s would never drop to 250 in the early morning, if there was antigen. He now takes my count at 6:30PM, and my cd4s are between 730 and 800. Dr. Markowitz was amazed at my huge 500 point gain over the course of a day, because he normally draws blood from his patients very early in the morning, and it may not be a accurate count in all patients when taken that early. Morning vs evening, could mean the difference between meds or no meds with some patients. When my personal doctor, Dr. Metroka, takes them at 8:30PM they are 805+ and peaked at 875. If your patients that showed a cd4 decline had their counts taken early in the morning, they may have the same extreme fluctuation I have, which is common in normal immune function, I have been told. You never told me if these patients had inverted ratios during the time they were your patients. If that is the case, that could explain the decline in their cd4s despite being undetectable in their blood. Inverted ratio means replication is occurring, but it is being controlled by the immune system. Dr. Metroka has only one other patient similar to me who has remained undetectable for over 20 years, but has always had an inverted ratio. I am the only patient hes had with a normal ratio, out of the 5000+ patients hes treated! Maybe my antibodies will disappear eventually, with possibly no replication. Dr. Metroka found only one case like mine in medical journals, a woman who tested positive, and had normal percentages, and was undetectable during the entire infection, and whos antibodies disappeared. She used it as an excuse to sue the doctor for a false positive, which in fact, when you test positive, it is always confirmed with a second test. So I doubt she was negative, and was just looking for an opportunity to get rich. The medical community I discovered tends to look at the glass as half empty rather than half full. Most would choose to believe she was never positive. Aaron Diamond has my blood frozen to prove if this ever happens to me. I have my fingers crossed.

One thing I had done before I was infected, is took a variety of antioxidants. I also took DHEA for 5 years prior to my infection. I think it could have been part the cause of my good luck. The trick is, I think you need to be taking them before youre infected, because they do you little good if you first start them after infection. I am continuing to take them, and have remained stable. Doctors do not want to believe this, because there is no medical evidence to support it. Doctors prefer the poison the virus theory, rather than the strengthening the immune system theory before infection. It amazes me how much the medical community still does not know, especially about time of day and cd4 counts.

I hope my LONG RESPONSE is helpful to you and others.

Thanks, David

MY FIRST QUESTION

What are the chances of myself remaining this good? Posted: Sep 6, 2004 Dear Doc, I have had HIV for a year now and have remained very stable. I am 43 years old. My CD4 count is between 802 and 850, and my CD8 count remains in the 400-460 range. I have also been undetectable <50 the entire time, with no blips, and had just completed seroconversion at the time of my first positive test. I have never needed meds and have always been <50. All I seem to have are the antibodies, the same situation if my body defeated any other virus. It is almost like I am vacinated (rare with HIV but there is a first for everything!). My CD4 percentage remains 40-50% and my CD8, 20%. My doctors have said that by looking at my bloodwork, if they didn't know I was positive, they would think there is nothing wrong with me. I am being studied by the Aaron Diamond project, and also have a great personal doctor who is a specialist. They all say my situation is very rare, and my unusal percectages, even more rare. They state that my low stable cd8 count/stable percentage is an indication that the virus is not replicating, would you agree? Since most people in my situation have inverted ratios, mine has never been inverted, and has been in the high normal range from day one, is it an indication it is not replicating in other areas, other than my blood? My doctors seem to believe that my body isn't detecting any antigen which is very good news. If it detected an antigen, my CD8's would be much higher I was told. Have you heard of others as lucky as myself, who remained stable, with my normal percentages, with no viral blips forever? Thanks, David

YOUR REPLY

Thanks for your post, moreover, thank you for volunteering your time at the Aaron Diamond Center. You've got some of the world's most respected doctors and researchers there (indeed, they're likely to be more up to date on the topic that you've asked than I). Yes, your situation is very unusual-- well less than 1% of persons infected with HIV. If there is any viral replication going on in your body, it must be doing it at extremely low levels. That said, forever is a very long time; I've had two patients in my career that were like you (with undetectable viral loads, but infected for years) who had very slow declines in their CD4 counts. One eventually had his viral load become intermittently detectable and had his CD4 count drop to below 300-- prompting treatment. Either way, yours seems like a very fortunate situation and I don't expect any significant drop in your immune function for a very, very long time. Thanks for reading. BY

Response from Dr. Young

David- thanks for your thoughtful follow up. I'm sure that our readers will be interested.

BY



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