My husband has been faithfully on meds since diagnosed, for the last 1.5 years. His viral load is now undetectable but his CD4 count is still low, 170. It's been holding steady there. It seems you do not recommend IL2. Is this still true? What do you recommend he do to increase the CD4 count? We would like it to get above 200. Are there nutritional supplements to try? Please let me know if there is *anything* we can do to increase it.

Thank you for your posting.

You are correct that I generally do not recommend IL2 because it is associated with considerable toxicity and at this time there is no convincing data that it changes outcomes. In fact, I believe that most patients like your husband will remain healthy regardless of CD4 cell count as long as their viral load remains undetectable. Nevertheless, I certainly understand why people remain concerned when the numbers are below 200 cells/uL.

Other than reassuring people that everything will likely be okay as long as they continue to take there therapy consistently I do encourage them to discuss with their provider whether there is any hint that the relatively low CD4 cells are gradually coming up, in which case more time may be the solution or whether there are other medications that might be holding them down. In addition, there is some data showing that CD4 cell increases are somewhat greater in those taking tenofovir or abacavir compared to zidovudine as well as those taking select protease inhibitors compared to NNRTIs. Consequently, all of these issues can be discussed, recognizing that it is not currently known whether the CD4 differences noted in these various studies translates into any clinical difference.

Best, Eric