long-term studies of those starting treatment "late"
Mar 8, 2011
hello, thanks in advance for your help with my question, and I hope it is an appropriate section to place this question. Although I've stopped kicking myself for it, my story is that 6 months ago when I was diagnosed, my t-cell count was only 14 and my viral load approached a million. I was fortunate to survive that time, although I had no major opportunistic infections, I wrestled with a chronic skin rash for many months and was hospitalized due to a "fever of unknown origin". At that time my total white blood count was under 100. I was put in isolation and given injections for neutropenia that temporarily raised the WBC to normal levels, alhtough it has since fallen but appears to be on a gradual increase approaching the bottom of normal range. I'm taking truvata and isentress. During the first 6 weeks, I saw a radical improvement,t-cell count from 14 to 94 and viral load decreased to around a thousand. After 4 months, my viral load was undetectable but my t-cell count is growing very slowly, it was 109 at that point, so I'm also taking Bactrim and Azythromycin regularly. I eat right, sleep enough, work hard, enjoy life, and have started exercising again, and take a Metrx protein mix and numerous vitamins. My question is... honestly, how can I expect to fare relative to that of someone who started treatment sooner? If my t-cell count continues to climb and I stay undetectable, what should my long-term expectations be? I'm 49. Should I plan for retirement or should I expect that in all likeihood I won't make it that far, to my late 60s?
Response from Mr. Vergel
It is impossible to predict how people respond long term, so let me get this out of the way first before I elaborate. I know many people who had 4 CD4 cells and who now have 800 after 15 years. They seem to be doing great.
Having said that, more and more studies are starting to link nadir CD4 cells (meaning, your lowest CD4 cells before starting treatment, in your case 14) and lower cognitive function after years of suppressed viral load, so that is something you should be aware of. Also, body shape changes may, and I say may since there is no conclusive evidence in randomized studies, also be more pronounced in those who start at low CD4 cells. Some argue that memory CD4 cell populations sometimes do not recover all the way in those who have gone so far down in the past, but that is still debatable. Memory CD4 cells are the ones that "remember" a pathogen they have been exposed in the past and are more readily effective in inciting a response to them.
You are taking a very good regimen that luckily brought your viral load down fast. Now it is your job to completely take care of yourself by eating well, exercising, avoiding co-infections like STDs, and adhering to your medications.
There is some evidence that starting HIV treatments in older patients may not show the robust CD4 increases seen in younger ones, but this is counter balanced by the fact that older patients seem to have better adherence to their medications, so I think it is a wash after all is said and done.
Plan for a long life. Do not change your plans. Well, may be change one: enjoy every day to the max and be thankful for a second chance.
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