High CD4, even with 5K-10K Viral Load

Question

Dr. Cohen, I work for a Family Practice Doctor who is very effective in HIV treatment. Not being a computer user, he asked me to see what insight you have on this topic. It seems many patients have had considerable success in maintaining CD4 counts (1000-1100), despite having Viral Loads in the 5,000-15,000 range. Do we have any updates from the most recent conferences on the viability of the infected T-cells? Is there good evidence of immune reconstitution? Obvioulsy the goal is to decrease VL, to undetectable levels, but he is puzzled by the apparently solid CD4 levels. Thank you!!!

Answer

There may not be a major puzzle in what you describe. The viral load levels of 5-10,000 are in general considered "low" - meaning that on average someone with that low level will lose about 30 cells per year - and if someone starts with around 1000 - then it may be a few years before they will head to, an average count of 900. And with CD4 fluctuations, there can be individuals who may do better than this - including the possibility that those with the highest counts may be better able to replicate cells and maintain the count depsite any damage done by HIV.

There was no update at the conference on this issue - except to note that some have an immune system that is better than average at controlling the CD4 counts, while others have more CD4 loss at any given viral load. Also keep in mind the test being used - the PCR test result is in general twice as high as a bDNA test - so that if you are doing a PCR with a result of 5-15K, that is similar to a bDNA of 2.5-7K - which may sound more like what you would expect to see in someone with a prolonged stable CD4 count...

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