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why does my CD4 count not improve? (LACK OF CD4 RESPONSE DESPITE TREATMENT, 2010)
Apr 23, 2010

Dr. Franscino, I am a 50 yr old caucasian male. I was diagnosed in June, 2008. At that time my CD4 was around 36 and my VL was well over 350,000. I had symptoms of wasting plus sweats and constant 101+ fevers. It took me two weeks to get in to see an AIDS Dr. here in Mississippi and was started on Atripla, bactrim and zithromycin (the latter has been discontinued). I have been 100% compliant, never missing a single dose. My VL was undetectable after about 9 mos., but my CD4 seems to have peaked at around 260 (highest reading 3 mos ago) and at my last visit was back down to 175 :( . The percentages are consistently 24-27% for the past year or so. Is there anything else I can do to raise the CD4 count? My Dr. says HGH is to risky (side effects) and IL2 is still too experimental, expensive, and not shown to make anyone "healthier" even tho it can at least temporarily boost the memory CD4 count. HELP???!!!

Response from Dr. Frascino

Hello,

There are a number of potential reasons immune reconstitution (rise in CD4 count) may falter, and they are all complex in nature. These include, among others, ongoing immune inflammation caused by HIV (even when HIV viral load is suppressed to undetectable levels), inadequate functioning of your thymus gland and damage to the architecture of the lymphoid tissues. I would agree with your doctor's advice on IL2 (not helpful) and HGH (many side effects).

There is no doubt that HIVers with suppressed HIV replication, i.e. undetectable viral loads, (even if CD4 response is relative weak) fare better clinically compared to patients not on combination antiretroviral therapy. Consequently treatment is still very much warranted even in those with a poor CD4 response. We are learning more about chronic inflammation and the other potential causes of poor immune reconstitution. Your situation is not uncommon.

This is yet another reasons for early diagnosis and treatment before the CD4 count falls and immune damage occurs.

Stay tuned to this site and we'll keep you posted as this story evolves and more effective treatments come online. One option now would be to try a protease and/or integrase inhibitor-based regimen. This sometimes will give a boost to the CD4 count while continuing to keep the viral load maximally suppressed.

Good luck.

Dr. Bob



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