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one year on and cd4 still low
Sep 14, 2008

Hi there thanks for invaluble insight into my condition i found out i was hiv+ feb 2006 with a viral load of 15000 and cd4 off 250 which has gone up and down during that year to 350 and then back to 225 so i started on kivexsa and sustiva combo this time last year which made my viral load undetectible but my cd4 has still not got over 308 i don't think this is normal i asked my doctor but he said i was fine because i had a percentage of 47. but still 308 is low. will i be o.k ? if it never goes back up or am i doomed to a short life please can you give me some insight

Response from Dr. Sherer

Around 10-15% of patients have good virologic control with sub-optimal CD4 cell increases. It is helpful that your provide your CD4 percentage, because 47% is usually associated with a count higher than 308 - more like 500+ - and leads me to wonder if you have lymphopenia contributing to your low CD4 cell count. You and your doctor could explore the possibility of additional causes of a low lymphocyte count by looking at peripheral smears, doing a bone marrow biopsy, and testing for conditions known to affect the bone marrow and lymphocyte production. You may also be on other medications that are associated with lymphopenia.

However, in general, you have achieved a safe level of CD4 cell, you have acheived full virologic suppression, and you are doing clinically well, so in many ways you have had an excellent response to your ART. I would suggest that you take these observations with you to your next MD visit and talk them over with your doctor. I would agree with your doctor that at this point no specific further intervention is needed.

"Doomed to a short life" is rather strong language! According to recent CDC data, the average life expectancy for a person living with HIV grew from 10 years to 21 years from 1996 to 2004. And according to the MACS natural history study, a 35 year old person with HIV who has never had an AIDS-defining condition can expect to live to age 69 years, which is 10 years less than those without HIV in the MACS (whose life expectancy was to age 79). On the other hand, if a person with HIV had ever had an AIDS defining condition, their life expectancy was lower - 49 yrs.

Also of interest in the MACS data, the most common causes of death were non-AIDS causes like heart disease, liver and kidney disease, and cancer, in 2/3 of patients, while HIV/AIDS was the cause of death in 1/3.

So I'm not sure how you would describe a life expectancy of 69 for people who are on treatment and who never had an AIDS defining illness, but I don't think 'doomed to a short life' fits.

One clear message from these data is that treatment before a person becomes sick with HIV/AIDS is a critical priority.

I urge you to talk to your doctor about your concerns and these responses.

Pheno testing
Genotype test and drugs I'm not taking.

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