Question

I WAS ON COMIVIRE AND VIRAMUNE FOR TEN YEARS T-CELLS ALWAYS 300'S THEN I SWICHED TO ATRIPLA FOR AT LAEST 6 YEARS NOW T-CELLS STLL ALWAYS 200-LOW B3'S NEVER HIGHER SINCE STARTING MEDS ALWAYS UNDETECTABLE . AND STILL WHAT WOULD BE THE BEST NEXT DRUG CHOICE FOR ME TO TRY TO BRING T-CELLS UP MORE DR MENTIONED IT LAST VISIT . i seem to be having alot of skin beakouts ect . would increase t-cells help over all health

Answer

Perhaps 10-25% of patients have poor or slow recovery of CD4 cells despite good viral suppression. Reasons are variable and include-severe scarring of lymph nodes from initial infection, older age, small/involuted thymus gland (source of CD4 T-helper cells), ongoing inflammation in the tissues, leakage of bacterial products from the gut into the blood stream, genetics, and other factors. Many of those factors are more pronounced the lower the CD4 count is before starting HIV medications(termed the CD4 nadir). For example many patients with a CD4 count< 50-100 when starting treatment have incomplete CD4 recovery even after many years of treatment. Switching from one effective HIV regimen to another doesn't usually improve the CD4 count in situations like yours. Efforts have been made to boost the CD4 count with interleukin-2 but there was no clinical benefit in the major study looking at that treatment. Additional intervention to decreases scarring (ie with losartan) or decrease inflammation are being studied but no intervention can be recommended for now.If your HIV level is undetectable that is a good thing and generally confers more protection against AIDS and other events than what would be expected for a given CD4 count.Bottom line-no easy way now available to further boost the CD4 count but viral to continue effective HIV treatment. KH