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Boyfriend CD4 Count 85
Feb 25, 2004

Recently my boyfriend found out he tested positive for HIV. He had gone to Thailand with a job offer and lived there for over 2 years. He met a Thai girl there who he fell in love with and he thought he could trust her, she told him she had cervical cancer when she was sick and he took her to the hospital and the Dr's told him it wasn't HIV, when infact it was. They broke up, he came back to the US and met me. We were together stupidly without protection and have been together for going on 5 months. He had his throat bothering him, so he went to the Dr to find out if it was cancer..he got tested and came back positive for HIV..he told me the same day he found out and I went to get tested and found out I was also HIV positive. We went back to the Doctor yesterday and his Cd4 count was 85 and like 16 .. He is afraid to show emotion in front of me because when he does I cry. Does he have AIDS? He is not sick..at all, he works 6 days a week, 12 hour days and is on medication for his throat being diagnosed with Tonisilitis. The dr tried to tell him that his CD4 count could have dropped quite a bit from that. And also the Dr was very optomistic that his health was in such perfect condition . I just can't help thinking that he is going to die. The dr is wanting to put him on a combo medication. He is waiting for insurance to kick in..another week or two maximum. He cried last night and acted like he was dying. When he's on these medications is it possible to shoot his CD4 count well above 200? So is it possible from having AIDS to go back to HIV? I'm confused! Can someone live a perfectly healthy life with a CD4 count of 85? They don't have his viral load count back yet, but he wil lhave that in 2 weeks. What can I do for him? I really am so scared. I know he is too..I worry about him hurting himself with no hope left. He constantly blames himself for having me involved and he had no idea. He also has herpes. I don't know if this makes a difference.Please let me know what all of this means.

Very Scared

Response from Dr. Lee

Your letter brings up a concern for me because there is only one sentence that is directly about you. You said: "I went to get tested and found out I was also HIV positive." Otherwise you write nothing more about your own concerns or status, but only about your boyfriend. It is nice to care so much for someone else, but it is critical that you care about yourself. I hope that you will please focus also on your own health and needs and take care of yourself!

I am sorry that you are learning such hard lessons about trust, safer sex, etc. I understand that you and your boyfriend would feel very overwhelmed with all that is happening. First I would urge you and your boyfriend to be sure that the doctor you are seeing is very experienced in HIV care. The fact that your boyfriend probably became infected in Thailand may make a difference in possibilities of resistance or other characteristics of the virus.

The definition of when HIV infection becomes AIDS is set by criteria that have been studied and agreed upon by the Centers for Disease Control (CDC). The criteria are based on factors that can be tested, such as CD4 cell count or the presence of specific "opportunistic" infections. The determination that a persons HIV disease has passed into AIDS is not necessarily connected to how they feel. Although usually the fatigue, weight loss, and other symptoms are associated with the illnesses that are used to define AIDS, that is not always the case. A CD4 of 200 or less is one criteria for HIV to be classed as AIDS.

I have had several patients with T cells lower than 20 who have no symptoms and who have told me they feel well and who have continued working in spite of having a very damaged immune system. The key is the immune system does not directly affect how we feel in terms of energy, muscle mass, etc. The immune system only comes into play when we are exposed to and can't fight back at infectious bacteria, viruses, or other germs that make us feel sick.

That is why HIV is such a sneaky or "silent" disease. Often effects aren't obvious until very late in the disease. So, yes it is possible for someone to live a perfectly healthy life with a CD4 count of 85.

The medications are usually very effective (if they are taken properly) in controlling the virus. The current medications that are available don't kill the virus, but mainly act like "birth control" to keep the virus from reproducing and infecting new cells. So, as the body makes new CD4 cells and the virus is controlled (and is not infecting those new CD4 cells), it is indeed possible to shoot the CD4 (or T cell) lymphocyte count well above 200.

An example is a patient of mine (I've been at this since 1985), a fellow who had a CD4 level of 3 in 1993 and suffered from several opportunistic infections before the 1996 combinations were available. He has since gone onto full combination treatment and his CD4 count went up over 400 and has stayed over 400. He gained back weight and a few years ago went back to work full-time!

So is it possible from having AIDS to go back to HIV? Not officially. That is, once a person has had enough immune damage or has experienced an opportunistic infection, their disease status is classed as AIDS. But, can a person get better and do well inspite of the disease classification? DEFINITELY!


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