I'm a 42 yr. old man. I was dx. with HIV at 36, t cells were 147, VL at 75,000, I had thrush and shingles. I am now at VL of less than 75 copies per ml.and a t cell count of 900, it dropped 300 points in 3 months. Should I have been given an AIDS dx. at the time? What is my life expectancy? Thank you, Terry M.

Hello Terry,

You do have an AIDS diagnosis. One of the diagnostic criteria is a CD4 (T-cell) count that falls below 200. Even if the count subsequently comes back up, the AIDS diagnosis remains. (See below.)

Life expectancy? Well, unfortunately none of has an infallible crystal ball (except for maybe Professor Trelawney in the Harry Potter books.) Effective HIV medications have only been available since 1996; consequently, we still don't have long-term data on the duration of their efficacy. Plus new novel therapies are continuing to be developed integrase inhibitors and CCR5 antagonists are scheduled for FDA approval this year. So the best we can say is that "our" prognosis continues to improve and we should all be cautiously optimistic about the future.

Let's get through this together, OK Terry?

Dr. Bob

t-cell count determines hiv or aids diagnosis? Jul 21, 2006

I remember my doctor at the time told me if my t-cell count dropped below 200, I would be considered to have Aids, but until then I am HIV+. Is this true? My t-cell count has dropped as low as 48, but is currently over 300. Can a person go from Hiv+ to having Aids to being considered Hiv+ again? I find people, being the public are more accepting of an hiv diagnosis rather than an aids diagnosis.

I know it's a silly question, but one I have thought about for some time now.

Thank you

Response from Dr. Frascino

Hi,

I'll repost below a question and response from the archives that addresses this concern. In brief, once a diagnosis of AIDS has been made, it is not rescinded, even if the CD4 count rebounds or the AIDS-defining opportunistic infection is completely cleared. I should also mention we no longer use the terminology "full-blown AIDS", as there is not such thing as "partially blown AIDS".

Your question is not silly. That 25 years into the pandemic "the public is more accepting of an HIV diagnosis than and AIDS diagnosis" is what's really silly! It shows we still have a long way to go in educating John Q. Public about HIV/AIDS. Unfortunately that education process is made all the more difficult by our current administration's backwards policy on sex education and HIV prevention together with the Republicans in Congress bowing to pressure from religious extremists. Let's hope this situation will be at least partially resolved with the upcoming mid-term elections.

Dr. Bob

AIDS OR NOT, THATS THE QUESTION Jun 12, 2005

Dr. Bob

On 5/24/05 the posted question about AIDS classification leaves me puzzled. In 1997 ZI was diagnosed with AIDS. My cd4 was 45 and I had several opportunistic infections. At that time I was given an full blown AIDS diagnosis. Four years later my cd4 was over 600, my viral load undetectable and my diagnosis was changed to HIV+. At that time my doctor was one of the tops in the field of AIDS research and treatment. I queried him about the change in diagnosis and he said CDC guideline had changed. Your answer on 5/24/05 leaves me wondering, who is right, who is wrong, and why the difference?

William

Response from Dr. Frascino

Hi William,

The CDC has not changed their HIV/AIDS diagnosis/classification criteria. So I guess that makes me right, him wrong and overall really not much difference as I explained in the response I previously posted. (Reprinted below.)

Dr. Bob

AIDS classification question Posted: May 24, 2005

Hi Dr. Bob,

I wrote to you regarding a question in the "Am I Infected?" forum.. and I'm not sure if this is the right place for my question -- but I always take consolation in the manner that you interact with people, so I'm hoping that you'd be able to answer this question -- which, arguably, could be placed elsewhere.

My friend's CD4 count, sadly, is in the high 90s. It's my understanding that this classifies him as having AIDS (I think the number is 200?) I believe he's been HIV+ for between 3-5 years. Is it possible, at this lowered state, that he would be able to increase this count/reduce the VL to a level that would not be considered AIDS? (I'm sorry for the crude phrasing of this question; but I'm not as educated in this topic as I'd like to be) It breaks my heart that I can't help him more -- his paticular strain has become resistant to his meds and he is going to start a sort of "trial" medication in the next week or so, which hopefully will help.

I guess my question is: is there a chance that with medication, lots of care and support, that he could recover from the low CD4/VL count? It's times like this I wish I had an M.D., too, and could do something medically instead of just emotionally. This message is quite somber, for which I apologize -- but this is my first friend who is HIV+, it's tough to be strong when I see him not doing so well -- and I just want to be there for him in any way possible.

Any advice or insight you have (despite perhaps the incorrect forum classification) would truly be appreciated.

Stay well, Dr. Bob. You're an inspiration.

-- TPF

Dr. Bob's response:

Hello TPF,

Anyone with either an AIDS indicator condition or a CD4 cell count of less than 200 has a diagnosis of full blown AIDS. However, the relevance of this diagnosis is more historical and epidemiological than clinical. HIV disease is a spectrum that goes from mild, asymptomatic disease to severe, symptomatic disease. There are folks with a full-blown AIDS diagnosis, who at the present time are feeling quite well, and likewise, there are people who do not "qualify" for the AIDS diagnosis, who are very symptomatic and ill. The CDC classification of full blown AIDS is used as a criterion for tracking the epidemic and allocating federal funds. Reporting requirements for HIV infection (not full blown AIDS) vary from state to state. However all cases of AIDS must, by law, be reported to the health department. Next, is there a chance that with the proper treatment your friend could significantly increase his CD4 count (above 200) and reduce his viral load to undetectable? Yes! If his trial medications can suppress HIV viral replication, his CD4 count will rebound. Working closely with a competent and compassionate HIV specialist is crucial. Sometimes getting a second opinion form another HIV specialist can be helpful, if things are not going well.

If your friend's CD4 count does increase above 200, will he still have a full-blown AIDS diagnosis? Yes, once this diagnosis of AIDS is made, it is not negated by subsequent developments, even if treatment produces a remarkable degree of immune reconstitution. However, do remember it's your friend's health and immune status that are important, not a "diagnosis" made primarily for surveillance purposes.

Finally, I should point out: don't wish to be an M.D. to help your friend. Chances are he'll have more than enough doctors involved in his care. What most HIV folks need are friends. A true friend is often more potent, soothing and healing than any medical intervention.

Good luck to both you and your friend.

Dr. Bob