|Immune restoration and Staying Undetectable
Feb 12, 2005
I started treatment 1999. And have taken the following ARV drugs: Regime1:Zidovudine(AZT) and Videx = this was my initial treatment. At the time Viral load was: 160 000 and CD4 250. I was loosing weight fast. In 3 months... CD4 was 550 and Viral load: 400... In 2001... two blood test viral load increased and CD4 GOING down... dr. suggested I changed to "see regime two below. Regime2: 3TC, Zerit & Viramune = Took for 2 years... and my CD4 was always around 600 until... viral load increased from below 200 to 15000 then to 30000 and dr. suggested again I changed to regime 3 which is the main reason I wanted to ask a question. Regime3: Protease inhibitors: Novir and Fotovase... 2 times a day. When I started my viral load was around 30 000 and CD4 around 400. In six months it was undetectable and another six months undetectable and CD4 remained in the range of 500 - 600 UNTIL NOW. My results just came back. And now my CD4 IS: 1130. & viral load was: 50. The questions I wanted to ask, is that. 1. Full Immune restoration: the high CD4 is it an indication of my body doing well and having my immune system restored to damages that may have been caused by the disease (HIV). And what could be the reason for the good result... except that adherence... can food supplements contribute... as I have been on and off... maybe 4 months in a year would take DHEA supplements...!and other things like energy boosters...(did clear with dr.)
2. Resistance: I was reading one of the articles in this site, which mentioned that a normal CD4 ranges from 800 - 1200. Am I having normal CD4 count. And what can I do to prevent a drug resistance? and lets say if resistance does occur what would be the best option (next regime). Cause I don't think I'll manage taking medicine 3 times a day...!
3. How long before I develop a resistance... in the current regime?
"apology for the long text, but wanted to give a history so that when I ask my question you know my background"
Response from Dr. Sherer
The following analogy is useful to understand the immune defiency caused by HIV, and the immune restoration that results from HAART. (Attribution to Jay Levy at UCSF): The components of your immune response are like scrabble letters. As HIV causes the CD4 cell count to fall, it eliminates some letters, in some cases permanently. The lower the CD4 cell count, the more likely the depletion is to be permanent.
HAART first restores CD4 cells in the first 6 months by preserving 'memory' CD4 cells that are already programmed for certain immune activities. After 6 months 'naive' CD4 cells begin to be restored that can respond with the full repertoire of immune response. However, there is evidence that this is never a complete process - some capabilities are lost permanently.
To return to the scrabble peices, this means that some letters are lost for good. Without a 'z', the immune system may never again spell 'zebra', though it can spell 'black and white striped horse'.
Whether this has serious implications for patients depends on how low the CD4 cell count dipped, and for how long. As your lowest CD4 cell count was above 200 cells/ml, it is less likely that serious selective immune deficiency will be an issue for you.
Still, there are unusual cases of people having good CD4 cell rises, only to develop a single opportunistic infection, e.g. with CMV, even when the CD4 cell count is 400, due to this type of selective deficiency.
There is little data regarding the impact of vitamin supplements and nutrition on the degree of rise of CD4 cells, or on this issue of selective deficiency. There is evidence that nutrition is critical, in that malnutrition in the developing world (as well as abundant parasitic infections and other endemic illnesses) is associated with a shorter natural history for HIV. In the US, 10 years on average elapses between infection and the onset of AIDS OIs. In Kenya, the average is 5 years, for example.
To your final question, if you remain adherent to your current regimen, it is possible that resistance is suppressed successfully for a long period of time - 6 years or more have been observed in clinical trials.
Long term suppression of resistance is a particular strength of protease inhibitor regimens, particularly when started in drug naive pateints.
I urge you to share these observations with your doctor, and discuss the implications for your case with him or her.
viramune / combo failure
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