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How usual/unusual are these T cell trends?
Mar 20, 2005

Hi, Dr. Sherer: Thanks for your forum.

HIV poz for 3 years. A few months after infection in early 2002, my CD4's went down to 600, which was lowest since infection...CD4 percent stayed in the low 40's that year, then went down t0 34% a year after infection for 6 months, though recovered to the 42 to 48 % range from then on.

My Q is this: my CD4 percent, after staying in the 42 to 48% range in the second and third year after infection, is at 52% in the most recent T cell subset, which is the highest ever (CD4 absolute 1,020...usually in the 680 to 900 range in the past couple of years).

My Q is this: I thought CD4 % usually goes down in untreated HIV infection? How unusual is my trend and the above numbers three years into untreated HIV infection? I'd be very glad for the results except for bad symptoms that I've had from day one and cannot figure out, because I gather they are not typical for normal CD4 counts and % (PN, muscular weakness, intractible nausea, tender throat nodes and pharyngitis).

Hope to hear from you...have you come across similar cases where untreated HIV results in a CD4% of 52% three years after infection and how unusual/significant is this?

Many thanks.

Response from Dr. Sherer

While the average response in CD4 count trends is to lose about 100 CD4 cells per year, the range of responses from individual to individual is quite broad. At the far end of the spectrum, long term non-progressors, who are only 1-2% of all infected persons, may take longer than 15 years to develop significant CD4 cell decline. So yes, this type of positive CD4 cell count trend has been seen before.

Your concern with symptoms is another matter, and one which I urge you to take up with your physician. In general, we recommend ART for any patient with significant symptoms. The clearest symptoms the meet this criteria are night sweats, unexplained weight loss, severe fatigue, and fever. You and your doctor can consider whether a trial of ART may be warranted to observe its effect, if any, on your current symptoms and signs. As a rule of thumb, I will take possible HIV-related signs and symptoms to be a possible indication for therapy if they are a significant disruption in the patient's life.

I will add that the signs and symptoms that you note may be unrelated to your HIV infection. Only your own physician can help you to answer this question.


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