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Past Forums (read only) >> Myths About HIV/AIDS

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TonyF
Regular

Reged: 02/13/09
Posts: 40
CD4+Tcell count indicative of nothing.
      #244660 - 02/18/09 05:19 PM

This, rather than being a myth the public promotes, could be considered a myth that the medical establishment promotes. We are led to believe that our bi-yearly doctor checkup of our CD4+Tcell count is a good baseline determination of where we stand immunologically. High CD4+Tcell count means that our body is doing great, and we are very far from a point of immune failure.

Well, a recent study finds that actually, CD4+Tcell monitoring is an absolute waste of time in terms of deciding how the body is doing in relation to mortality. People with 'good' numbers are just as likely to get immune failure as someone with dismal numbers.

Don't take my word for it: here's the study:
http://www.ncbi.nlm.nih.gov/pubmed/18989232

Makes me question of value of taking meds in order to control these numbers, when the numbers don't really have any significance to my health.

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sick_of_fuckwits
Master

Reged: 01/26/09
Posts: 145
Re: CD4+Tcell count indicative of nothing. new
      #244662 - 02/18/09 05:58 PM

Hmmmmmmm

There are multiple problems with the way you are reading and paraphrasing that study.
  • This is about resource-poor settings. Are you in such a setting?
  • It is talking about treatment and virologic failure - not immune failure.
  • It doesn't say that it doesn't predict virologic failure - it says that it may not be a totally accurate marker of virologic failure.
These may seem like unimportant details to you, but are a lot more than mere subtleties.

What this is cautioning is that doctors treating people in poorly resourced settings (mostly in Africa), where they probably don't have easy / cheap access to any form of viral load testing, need to be cautious when making decisions about treatment switches based solely on movements in CD4 cell counts. That isn't something that a doctor would ever consider doing anywhere in the developed world, where CD4 count is just one single element of your numbers.

Read the detail and they are very clear in stating that both CD4 counts and viral load are independently associated with disease progression. They also stress that CD4 cell counts have other benefits in monitoring patient health, including the need for prophylaxis against opportunistic infections and also to identify which patients need a viral load test (where it is available).

Also note the cautions that the authors themselves have added - namely the value of their analyses is severely limited by the small number of participants with treatment failure in their study and that this may underestimate the predictive power of CD4 cell counts.

Finally, you misunderstand the primary goal of treatment. It isn't to control your CD4 count - it is to control your viral load and disease progression. Rises in CD4 count are a secondary goal and all this report is advising is that WHO guidelines for treatment in the poorest countries need to be revised to ensure that more is made of treatment and to give better guidance on avoiding premature / late switching. Anything else you read into it is a product of your imagination .. and there is most definitely nothing in there to suggest that absolute CD4 cell count is any less good at determining where your immune system is.

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hopefulone
Master

Reged: 12/05/08
Posts: 130
Loc: NY, NY
Re: CD4+Tcell count indicative of nothing. new
      #244667 - 02/18/09 08:23 PM

thank you it is very reassuring knowing someone with knowledge is able to post to respond to questions and bring clairty to ambiguity. thanks

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sick_of_fuckwits
Master

Reged: 01/26/09
Posts: 145
Re: CD4+Tcell count indicative of nothing. new
      #244693 - 02/19/09 12:39 PM

And as if by magic, today on Aidsmap:

Treatment switches on basis of CD4 declines often unnecessary, Uganda research shows

Quote:

Switching people to second-line antiretroviral treatment on the basis of CD4 declines, without information from viral load tests, could result in a large numbers of unnecessary switches to more expensive second-line regimens in resource-limited settings, a study in Uganda has found.






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Robert1
All Star

Reged: 05/29/07
Posts: 96
Re: CD4+Tcell count indicative of nothing. new
      #245062 - 03/21/09 06:18 PM

A "myth" that medical experts promote. Ok so people who have gone through 5 years of medical school and years of postgraduate education know less than you? Every single infectious disease specialist in the U.S., every single HIV specialist, every single HIV nurse are duped and incompetent????One study does not make the truth. CD4 counts are not 100% but they tell a lot.

"Makes me question of value of taking meds in order to control these numbers, when the numbers don't really have any significance to my health."

You take meds to control your viral load ...and hopefully bring up your CD4 count. But if you don't believe the thousands of large clinical studies that have demonstrated that HIV medications will allow you to live a long life, that's your choice. Getting an undetectable viral load is worthwhile and has shown that you can extend your life.

Fear of medications is understandable. Having HIV means having a life threatening illness and this is hard to face. But don't commit suicide cause of fear! HIV medicine has made such incredible strides! Take advantage of it. People with other illnesses are not as lucky!




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Robert1
All Star

Reged: 05/29/07
Posts: 96
Re: CD4+Tcell count indicative of nothing. new
      #245150 - 03/27/09 09:14 PM

You really need to learn to read better. The conclusion of this study is
"CD4 cell count monitoring does not accurately identify individuals with virologic failure among patients taking ART." ALL that means is that in the developing world, where there are no viral load tests you cannot use their CD4 count to see if someone is failing treatment!!!!!!!!!!

Before you come to conclusions like this, you need to read the study. Also, one study is just one study!!

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allangering
Regular

Reged: 07/04/09
Posts: 46
Re: CD4+Tcell count indicative of nothing. new
      #247807 - 10/01/09 05:32 AM

The other much simpler reason that mortality went down around the same time the meds were introduced was that they changed the definition of AIDS patients to include healthy HIV positive people. Previously it had only included people who had AIDS-defining symptoms and thus were actually very sick. No wonder that the stats magically improved as from that point on, they suddenly included a lot of very healthy people!!

What is interesting though, is that the decline in deaths occurred well before the meds were changed - something like 12 months before! This in itself should cast doubt on any suggestion that it was the introduction of new meds that caused the improvement - they weren't introduced yet!
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Jackie__Blue
Legend

Reged: 01/20/07
Posts: 1186
Re: CD4+Tcell count indicative of nothing. new
      #247809 - 10/01/09 09:31 AM

You're so full of it. The defining parameters of AIDS is just the same. A CD4 under 200 or AIDS defining illnesses. The stats improved because the number of deaths went down.

Again, you make grand pronouncements, but back it up with nothing.



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