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Staying healthy
Mar 16, 2005

I have just got my first set of blood work back and the results were pretty good cd4 is 680 and viral load is 16,000.I got another set taken yesterday. I was wondering if there is a holistic way to keep my viral load down and cd4 up. I take a multi vitamin and have been eating a lot of fresh fruit and veggies.I'm in a 12 step recovery program and have been clean for 90days. However. I need to quit smoking but was told not to try to quit until after a year clean.I dont think my health should wait that long I wanted to try using the patch and wellbutron at the same time Thinking that it would be easier and not trigger a relaps. I've tryed them both separately and i still smoke but i hear that together they work well, what do you think?? Any other suggestions to stay healthy would be appreciated :)

Response from Dr. Pierone

We have a general understanding of the means by which HIV leads to the progressive depletion of the immune system. There is a triad of intrinsic viral factors, genetically determined immune functionalities, and environmental issues that are present in HIV infection. In any individual, the course and ultimate outcome is determined by the interaction of this triad.

Viral factors Some quasi-species of HIV are more aggressive and better able to colonize and destroy CD4 cells. Someone with the bad luck to become infected with a more virulent variant will tend to have a higher viral load and lose CD4 cells more rapidly.

Genetically determined immune functionality There are genetic differences in immune response that are passed down from parents to children. The HLA (human lymphocyte antigen) system is one of the ways that these differences can be explored. There is considerable evidence that certain HLA subtypes confer either relative resistance or sensitivity to HIV infection.

Well, although it might have been nice, we can't change parents, can't change virus, but we can change the environmental factors. This speaks to the holistic approach that you mentioned.

Environmental Issues The watchword here is immune activation. HIV is widely disseminated during the first several weeks after acquisition, and infects, but does not kill, many of the long-lived lymphocytes that contribute to our "immune memory". In response to infection, the immune system is activated and signals are sent out to this memory cells to respond. As these cells do respond, those that are latently infected with HIV are subverted by the virus and turned into virus producing factories. Thus, any process that produces immune activation can fast forward the natural course of HIV infection.

Smoking is an example. Besides increasing the risk of respiratory infection, smoking produces a daily death and carnage in lining cells of the sinuses, bronchi, and lung tissue. As these cells die from chemical/toxin exposure the immune system is activated to come and clean up the dead cells. These lymphocytes are also charged with the duty of responding to toxins, so there is a specific lymphocyte response to the panoply of toxins in smoke and more HIV factories are produced. This model of immune activation produced by chronic smoke exposure is substantiated by clinical trials that have demonstrated more rapid loss of CD4 cells in untreated smokers compared to non-smokers.

So quitting smoking is imperative for anyone that values life and health. To answer your question, you should act immediately, don't wait for a year. The combination of Wellbutrin and nicotine replacement therapy does increase quit rates. There are also smoking cessation programs that improve outcomes. Enlisting the aid of family and friends is also essential. If ones social network is chock full of committed smokers it makes it much tougher to withstand social pressure. Also, if at first you don't succeed, keep trying until it sticks. I smoked up until medical school (talk about anti-smoking social pressure) and probably threw away 30 packs of cigarettes after smoking one or two, a slow learner apparently :).

Other holistic approaches aimed at fostering health (and a quiet non-activated immune system) include regular exercise, a balanced diet with lots of nuts, fruits, and vegetables. Also, stress activates the immune system, so stress reduction is important as well. But the Godfather of immune activation is crystal methamphetamine, so avoid this stuff like the plague (which it actually is).

All of that said, it looks like your numbers are quite good and with the lifestyle changes you have initiated the future looks quite promising. Thanks for posting and let us know how things progress.



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