Low CD4 shortly after HIV infection

[tony_wdc20001]

I routinely have an HIV test every six months.  In Feb 2009, I went in for testing when I was battling a very bad flu. The test came back negative; however during an annual physical in July 2009 my test came back positive. I received counts and genotypes first week in August.  CD4 147; vl 40,803; genotype sensitive to all meds (no mutation).  

I began therapy immediately Truvada+Viramune.  Although my doctor was concerned with CD4 count he told me not to worry because it is not uncommon with initial infections to have a low CD4 and I could be at the bottom and they are on their way back up.

After reading several blogs and posting, I haven't seen anyone who disclosed a CD4 count below 240 during their first year of exposure.  Is there anyone out there who has a CD4 count below 200 within the first year?

[madbrain]

After reading several blogs and posting, I haven't seen anyone who disclosed a CD4 count below 240 during their first year of exposure.  Is there anyone out there who has a CD4 count below 200 within the first year?

My bf tested neg april 2006, poz november 2006. There was no flu for him or any sign of illness. His first labs were CD4 300, 13% and VL 4000. In January 2007, he went down to CD4 230, 9% and VL 35,000, which is pretty close to your labs. While his absolute CD4 wasn't below 200, his CD4 percentage was low enough to qualify him for AIDS from his very first labs (<14%) and it got worse quickly.

I know others in the Kaiser support group that got CD4 in the double or single digits within their first year of infection.

I haven't seen anyone in the forums report this kind of thing in the first person, but that doesn't mean it doesn't happen regularly. I think a lot of people don't test for HIV frequently so they can't say for sure when they were infected.

[shreveman]

Hello:

Thirteen years ago this month when I was diagnosed as having the virus, my CD4 count was only 66. I was immediately put on protease inhibitors and either a nuc or non-nucleioside inhibitor - I don't really remember now. I don't recall either what my viral load was - I see my ID doc this coming week and I may ask him that for historical purposes. Since that time I have consistently taken my medicines - I've never taken a "holiday", however, I am human and have missed a dose from time-to-time - it happens. The highest my CD4 count has ever been is around 465. It's somewhere around 400 now - I'll find out exactly later next week when I get my updated numbers. My thinking about having such a low initial CD4 count is that I went too long before I sought medical attention - that my immune system was already damaged and once that happens its hard or at least it was in my case for it to recover. That's one reason I've never taken a "holiday". I don't really know when I became exposed - it doesn't really matter now after all these years. I've seen some people have a lot better response than what I have had after they started on medicines and their CD4 count went to 1,000 something or more. Mainly what my doc is concerned with is keeping my viral load undectectable and not so much what the CD4 count is. I have had a period or two where my viral load became detectable (>50) and I had to switch medicines, but I have been on the same medicines now for 4 or 5 years and no problems - I take Kaletra and Viramune twice a day. I imagine you will see some improvement with your CD4 count and your VL will decrease after a period of time. All I can offer is try not to stress about having a low CD4 count and keep a watch on your viral load. Best of luck to you. R

[actupts]

After testing negative in 1990, 1991, and 1992, I was diagnosed with AIDS in 1993.  I believe I was infected around July 4, 1993, when I had decreasingly safe sex with someone who tested positive a few months later and who died of AIDS in 1997.  A few weeks later, I developed symptoms consistent with primary HIV infection, and after having repeatedly positive ELISAs but repeatedly positive, negative, and indeterminate Western Blots, I was diagnosed based on a viral culture and P24 antigen level.  The latter tests were ordered after the local health department invoked their rather paranoid "HIV+ healthcare worker" protocol.

While having CD4 counts done my doctor and by various studies I screened for, I watched my CD4 count drop from nearly 500 in early October 1993 to 338 (late October) and to less than 200 CD4 count in December 1993 and January 1994.  During this same time, I developed classic AIDS symptoms: neuropathy, oral candidiasis, major apthous ulcers, repeated skin infections, and  low red and white cell counts.   I also developed cognitive and behavioral problems during this time, which despite treatment with AZT, led to a 1995 diagnosis of early to moderate AIDS dementia.  I was also diagnosed with probable pneumocystis carinii pneumonia, HSV-1 infection, and intractable anal warts in 1995.

My CD4 counts bottomed out between one and two hundred in 1994, where they pretty much remained until the advent of protease inhibitor based HAART in 1996.  Treatment with D4T/3TC, or 3TC monotherapy had little effect.  Interestingly, my viral load was measured between 8,000 and 50,000 using the crude viral load tests available at the time through studies.

My unusually rapid progression has led to considerable problems with doctors.  Over the years, I have been told that what I what I am describing is impossible, that I am making up my claims of primary HIV-related neuropathy to get narcotics, that I am for, whatever, reason unwilling to admit to hundreds of sexual encounters, as it is unlikely I was infected despite my relative lack of sexual activity, etc, etc, etc.

Other doctors, early on, felt that I was a rare rapid progressor, and that I should get my affairs in order as they could only give me "some quality of life for as many months as possible." 

So, yes, it can happen and seems to happen with surprising frequency, based on the sheer number of people whose CD4 counts seemed to collapse.

[Ann]

Hi Tony, welcome to the forums.

It's not uncommon for someone who is diagnosed during primary infection (the first year or so of infection) to have a high viral load and low CD4s. During primary infection, the body is learning to cope with the new invader and how long it takes for someone to stabilise with improved numbers will vary from individual to individual.

What you also have to take into account is what was normal for your CD4s BEFORE infection. Unfortunately, it's rare to have this information. Normal for one person might have been between 900 and 1300, and for someone else, it might have been between 500 and 900. The former person might only drop down to 500 during primary, while the latter might drop to 100. Of course, the opposite could just as well be true. Maddening, isn't it?

Good luck with the meds, and hang in there.

Ann

[markaj]

My labs were fairly low in the first year, you can see the numbers below.  If I didn't start meds when I did I would have been on the way to full blown AIDS (UK criteria for diagnosis, I already fulfilled the US criteria).  My viral load showed no real signs of coming down by itself and would have continued to attack the CD4 cells I had. Starting meds is a good decision, good luck Tony.  Mark x

[prettyfighting1]

im pretty sure that i have this HIV for almost 2 and half years from now, I just found out im poz last may 29, 2009 and my cd4 count is only 134, never had flu or serious illness.. i hope i can start my treatment 1st week next month,, i feel healthy too nowadays...

[tony_wdc20001]

Thank you all for responding with your stories and stats; I am sure you do not need to guess how comforting and encouraging your posts are to me.  From what I gathered, I should not stress out, take my meds, and listen to my doctor.  BTW, I believe my doctor said I was at 12%.  I actually do not know what this percentage means, I would assume CD4 cell to VL copies -- I still have a lot to learn.  To our health and a cure, Thanks!

[madbrain]

BTW, I believe my doctor said I was at 12%.  I actually do not know what this percentage means, I would assume CD4 cell to VL copies -- I still have a lot to learn.

See http://www.aidsmeds.com/articles/TCellTest_4727.shtml .
A normal CD4 percentage is between 30 and 60 . Less than 13 is one of the AIDS-defining criteria, just like an absolute CD4 count less than 200 per the CDC definition.

[actupts]

I really wish that medical schools and AIDS community publications (e.g., Poz) would cover the subset of PWAs whose CD4 counts become critically low shortly after infection.

Most doctors are taught that one gets HIV, nothing happens for 10 years or so, and then one becomes symptomatic and in need of HAART or dead.  People who are rapid progressors or long term non-progressors are not taken seriously by doctors who learned in medical school that AIDS is a slow but inevitably fatal disease.

I sometimes wonder if the early studies of AIDS progression  were using skewed data.  Persons who were progressed rapidly and died prior to widespread HIV testing would not be seen as AIDS fatalities.  If someone was infected in 1980 and died in 1982 of AIDS-related bacterial pneumonia, they probably would not be counted as an AIDS death.  If, however, they were infected in 1980, tested positive in 1984, and died in 1994, they would be seen a ten year survival time.