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CD4 levels are tanking!
Aug 27, 2010

I have been in treatment since 1996. My viral load went undetectable with the additon of protease inhibitors in early '97. For the last few years I have been taking Norvir, Reytaz, and Combvir. All was swell until this year. CD4/% was 1035/35 in Jan, CD4 was 650 in May, now (Aug) my CD4/% is 255/28.3. That level is lower than when I was originally diagnosed (311).

I'm about to turn 60. My doctor was quite a bit less than insightful about my situation (I had to point out the marked drop).

This is scary. What can be done? Is there a resource I can be pointed to?

Response from Dr. Henry

CD4 counts are highly variable so often frustrating to explain trends esp in setting of good HIV control. CD4 production versus destruction balance depends on thymus function, degree of scarring in lymph tissues, level of immune activation, nutrition status, genetics,age, and other factors. There is often no easy fix if CD4 levels are stagnant or falling in setting of good HIV control (AZT can be a drag on bone marrow so perhaps a switch to alternative drug such as tenofovir or abacavir may be worth considering). Risk for AIDS event is low with good HIV control and CD4 count > 200 but that is little comfort if CD4 count is falling. A full nutrition/hormone and bone marrow assessment is worth discussing. Interleukin-2 has been tried in this setting with disappointing results. There is no effective and safe specific intervention for boosting CD4 counts in the setting of full HIV suppression. Aging also may impact CD4 production in some patients. Investigation approaches such as use of growth hormone like products are under evaluation as are anti-fibrosis meds thatn could reduce lymph node scarring. Disappointing that I can't offer anything more concrete with any confidence. KH



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