CD4 questions and a compliment
Oct 15, 2001
I began treatment (Comb and Sustiva) in May (bDNA 72K CD4 629 22, three months after being infected, and was tested in July (bDNA 377 CD4 627 33) and just last week (bDNA less than 50 CD4 630 35) Im still having vivid dreams but they are almost amusing! (1) Can I expect a rise in CD4 in the future? Is 600-650 just as good as 1000? Is it normal for there to be so little variation in CD4 absolute even if is rising? (2) What does the rise in percentage mean? (3) I take all my pills (though sometimes a couple of hours late). Doc says shes going to take me off the "cocktail" next year, though I think Id rather stay on. Is my fear of going off pills unfounded? (4) When do you think well get more than anecdotal information about STIs?
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Response from Dr. Pavia
Thanks for the plug.
The question about CD4 percents is a common one. The CD4 count is measured as the percentage of lymphocytes (a type of white blood cell) that are CD4+, meaning they are helper T cells times the number of lymphocytes. The lymphocyte count however, goes up and down for reasons that are unrelated to how well the HIV is doing. Therefore, we look at both numbers. It is a good thing that your CD4 percents are rising, along with the mild increase in CD4 number.
Normally, there is continued, slow increase in the CD4 count after a more impressive increase in the first year. However, once you are in the normal range (as you are) you may have reached your normal, and may or may not go up any further. Not to worry, many uninfected normal persons have CD4 counts of 600-700.
In general, I don't think there is any convincing evidence yet that STI's in chronically infected persons boost immunity to the virus or have a clear benefit. That is not to say that there are not good reasons to take a treatment break, whether to sort out a side effect, or to take a break when you are starting to have treatment fatigue and miss too many pills.
You pose an intersting problem. Many docs would not, in 2001, have started you on treatment yet. So, now that you are on treatment, and have a better CD4 count, is it reasonable to stop and wait until your CD4 count falls again, say to 300-400 cells? I don't know the absolute right answer to that, since there are no real data. I see it as a reasonable thing to thing about if you want to, or if you are having side effects. However, if you are uncomfortable with the idea, I would not push it. If it were me, and I had no side effects that were bothersome, I would probably hold tight. (When we really don't know, I think docs should try the "what would I do if it were me" approach to help clarify their thinking).
Hope this helps ATP
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