Dear DR, I have lived with this condition for over 11 years with an average CD4 of 650, ie it fluctuates between 500 to 1000, kindly share with me whether this can continue for ever, what are natural ways of boosting CD4? PETER

CD4 cell counts fluctuate more widely once they are above 500 CD4 cells/ml. You and your doctor can also review the CD4 percentage to check whether such fluctuations represent real changes, or just changes in the absolute CD4 cell count.

There are no known, i.e. proven, ways to increase the CD4 cell count 'naturally', i.e. by dietary supplements, exercise, meditation, or other means. In your case, there is no need; you have a near normal CD4 cell count, and no further enhancement is necessary.

Some medications do increase the CD4 cell count temporarily, for example IL-II. This was just studied in two major long term studies in patients with low and with higher CD4 cell counts, and, although an increase in around 40-50 CD4 cells was seen, there was no benefit in clinical outcomes, including mortality. Furthermore, once IL-II is withdrawn, the increase in CD4 cells is lost. Thus the increase does no good and is transient at best.

Interestingly, the new entry inhibitor miraviroc has been shown to increase CD4 cells by about 50 CD4 cells after one year of treatment, and this effect appears to be independent of the viral load suppressive effect of the drug. Whether this will prove to offer any additional therapeutic value beyond viral load suppression remains to be seen.