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A friend of mine is down to non-detectable levels; T-cells are still low. Why?
Apr 3, 2009

I am very concerned about my best friend. He tested positive for HIV in November of 2008; he was very sick, with something like 167,000 viral copies and T-cells in the single digits; he was put on Atripla immediately. His doctor just told him today that he is now "undetectable" as far as HIV copies are concerned, but that his T-cells are at 107. Shouldn't his T-cells be much higher than this? Does it usually take the T-cells longer to build up than it does for the viral load to become undetectable? What is the usual time frame for T-cells to rebound, or do they sometimes never rebound in some people?

Response from Dr. Frascino

Hello,

Unfortunately there is no "usual timeframe" for T-cell rebound! Every case is unique due to a wide range of variables that include both host factors (age, immune integrity, concurrent infections, adherence, genetics, etc.) and viral factors (viral strain, viral load, viral fitness, etc.). That your "very sick" friend was diagnosed in November 2008 with a CD4 count "in the single digits" and a high HIV plasma viral load of 167,000 copies and now on Atripla for five months he has an undetectable viral load and CD4 count of 107 demonstrates an excellent response to treatment. This is both virologic (HIV plasma viral load plummeting to undetectable levels) and immunologic (CD4 cell count dramatically rising from single digits to 107). This is a very significant and encouraging rise in CD4 cell count. Certainly your buddy is not out of the woods yet, but he's making great progress, which shows his combination antiretroviral regimen is working well to suppress viral replication and allow for some degree of immune reconstitution. Both you and he should be encouraged by these results. It is true that HIV replication and viral load need to decrease before CD4 counts can begin to rise. How quickly and how much they will rise is an unknown and varies considerably from patient to patient.

One comment. I find it disheartening that your friend, like so many other people, did not have his HIV disease diagnosed until such a late and dangerous stage when his immune system was already decimated by the virus and he was so "very sick!" This is a complete failure of our healthcare system and our HIV/AIDS awareness campaigns. Of course I do realize that many cases of late diagnosis like your friend's result from people being too afraid to get HIV tested. Again this is a tragedy, as this "paralyzed by fear" delay can have catastrophic consequences that could have easily been avoided by a more timely diagnosis. Let's hope that stories like your friend's will encourage others not to wait. When it comes to HIV/AIDS, what you don't know can kill you. Please give your buddy a hug from me. Also, turn him on to this site if he doesn't already know about it. There is much information here that he may find helpful.

Good luck to you both.

Dr. Bob



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