Question on rapid CD4 drop

[Dale Parker]

I have a friend of a friend (seriously) who tested positive about 6 weeks ago. They guy is pretty sure he contracted HIV in the spring of this year. If I remember right when he first tested his CD4's were about 750 and are now 300. I can't remember what his original viral load was but it's now 54,000. His doctor wants him to start meds right away. Any thoughts as to why they would drop so fast?
 This guy is going through almost the same scenario as I went through. He was laid off a month before testing positive, has housing problems, trying to get insurance for meds etc. I know he has lots of stress but I don't think that alone would explain the big drop in CD4's. He is also fairly healthy i.e. no colds, PCP etc. My friend is trying his best to get this guy to talk to me so I can guide him thru this give him my support and get him in touch with support groups but he doesn't want to talk to anyone. Mentally he is pretty down in the dumps. Even though this guy knows of my status I'm not supposed to know he's positive. My friend has tried to arrange for the three of us to have lunch and even tried to give him my phone number but he just won't go for it.
Thanks in advance for any thoughts on this.
Dale
 

[Inchlingblue]

Of course a drop like that could be any number of things but I had the same experience when I was first diagnosed and in my particular case it was due to stress, pure and simple.

Everyone is different but for whatever it's worth, this was my experience:

After first diagnosis my CD4s were about 650 and 3 weeks later they had dropped to about 350! I was not sick with any OIs (which could cause such a drop) but I was under a huge amount of stress, my reaction to the diagnosis was not good at all. I basically freaked out. When I look back it's very clear to me that this very high level of stress is what caused that precipitous drop in CD4s.

The weird thing is that my viral load actually dropped too. It went from about 24K to about 9k.

When we're so highly stressed many things happen in our bodies. A hormone called cortisol is released at high levels and this has been to shown to adversely affect the immune system.

I did not go on meds immediately, my doctor figured it was stress and he wanted to re-test in a month's time. Also, my VL was not high, which I think also played into the decision. My CD4s didn't go back to that 600 range but they did jump back up to the mid 400s. I eventually started meds a few months later, even though my numbers were still decent.

Assuming your friend doesn't have any underlying issues such as an OI and since his viral load is moderate, if he does not want to start meds or can't for any reason then it would be a good idea to test again in about 4 to 6 weeks and see where the numbers are. But if he wants to start and is able to start meds, then there's nothing wrong with that either.

[Dale Parker]

Thanks for the reply. I knew that stress could affect the CD4's but I figured 50 or 60, 100 at most. His doctor is worried about the drop and is suggesting going on meds. I know that he can't afford it and is waiting for his insurance to kick in. That should be in about 3 weeks but his doctor is going to try and speed that up. 
  I wish that he would call so I could tell him what I know. guide him thru the system and give him support.  Should be a short conversation. LOL Guess that you can lead a hose to water but can't make him drink.

[madbrain]

Of course a drop like that could be any number of things but I had the same experience when I was first diagnosed and in my particular case it was due to stress, pure and simple.

Everyone is different but for whatever it's worth, this was my experience:

After first diagnosis my CD4s were about 650 and 3 weeks later they had dropped to about 350! I was not sick with any OIs (which could cause such a drop) but I was under a huge amount of stress, my reaction to the diagnosis was not good at all. I basically freaked out. When I look back it's very clear to me that this very high level of stress is what caused that precipitous drop in CD4s.

The weird thing is that my viral load actually dropped too. It went from about 24K to about 9k.

When we're so highly stressed many things happen in our bodies. A hormone called cortisol is released at high levels and this has been to shown to adversely affect the immune system.

I did not go on meds immediately, my doctor figured it was stress and he wanted to re-test in a month's time. Also, my VL was not high, which I think also played into the decision. My CD4s didn't go back to that 600 range but they did jump back up to the mid 400s. I eventually started meds a few months later, even though my numbers were still decent.

Assuming your friend doesn't have any underlying issues such as an OI and since his viral load is moderate, if he does not want to start meds or can't for any reason then it would be a good idea to test again in about 4 to 6 weeks and see where the numbers are. But if he wants to start and is able to start meds, then there's nothing wrong with that either.

While I don't want to downplay the influence of stress on CD4 counts, I do want to point out that there may be other reasons for rapid drops. Some individuals are genetically more susceptible to HIV than others. Even 2 individuals infected with the same strain can progress very differently.

Case in point - I was stressed liked hell for a year after my own diagnosis, and that of my bf, I went on disability, lost my job, then worked part time. Yet my CD4s didn't drop.

Regardless of the cause of the CD4 drop, if it is prolonged and you find yourself with numbers within the guidelines to start treatment, then it would be wise to consider it.

[Inchlingblue]

I agree and I mention it in my post, that there could be many reasons for sharp CD4 declines, I'm just saying that in my particular case it was stress.

I was likely infected for at least a few years and it makes no sense, other than the extreme stress, for me to have had that huge drop at that particular point in time, right after diagnosis, especially with my fairly low viral load. And when I say extreme stress, I mean EXTREME, lol . . . You mention you were stressed as hell after diagnosis and I don't doubt that. I think everyone experiences stress after finding out about HIV and having to deal with it on top of life's other challenges.

Maybe the word "stress" is not strong enough to describe what I was feeling. I don't want to go into it here, but trust me, I was freaking out in a  big way for several weeks before I began to calm down. It's hard to know 100% for sure but I am 99.9% sure that if I had not freaked out as much as I did, I would not have had that huge drop (over 300 in 3 weeks).
 
The reason I think it's important to stress that in my case it was stress (ha ha pun intended), is that people out there who are newly diagnosed should realize that having a reaction such as mine can possibly cause some real harm and it might be enough of an incentive to try and remain as calm as possible.

But I agree that there are those out there who are fast progressors as well, no question.