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CD4 increases and aging
Aug 28, 2013

Dear Doctor,

I've sometimes seen it written on this site that as we age while on ART our immune system becomes less competent to reconstitute the CD4 count that had been depleted during years of uncontrolled virus.

This claim is bugging me because I feel as if I'm living with an age-related stricture that puts a lid on what I can hope to therapeutically gain under ART as I get older. I'm hoping you can provide some detail to justify this.

Based on your clinical observations, or any literature, what can an ART patient over 50 expect in regard to immune reconstitution (specifically CD4s)? Is there a point in the natural aging process, with or without HIV, when CD4s can no longer be substantially regenerated? Please help me to separate evidence from urban myth in this regard.

FYI, I'm 50+, 25+ years with HIV, on Atripla for 8 years, most recent CD4 836, started on Atripla at 210.

Thanks, Inquisitive

Response from Dr. Young

Hello and thanks for posting.

It is clear that as we age (or at least when we're old), our immune systems don't always function as well as when younger. This is why older people have a higher rate of pneumonia and shingles, for example.

It's also clear from large HIV cohort studies that older people living with HIV have a somewhat lower (~25% in the NA-ACCORD study) likelihood of having an adequate CD4 cell response compared with people age 18-29.

Results from the ATHENA clinical study show that individuals over the age of 50 have less CD4 cell increases after starting ART.

Together, these data provide (additional) support for starting treatment earlier, especially in older individuals.

In your circumstance, you have clearly had a robust CD4 cell increase- well into the normal range, so I think that there's little to worry about from this aspect.

For more information about aging healthy with HIV, check out our pages at

Be well, BY

Two small bumps right under and behind my earlobes.

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