POZ Community Forums
Main Forums => Living With HIV => Topic started by: loop78 on June 26, 2008, 04:42:06 am
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Hey everyone,
I just came back from my appointment with my doctor. The results from the the blood draw I had this Monday were in and, boy, have things changed in a month!
CD4 count has gone up to 441 from 235. However CD4 percentage has gone down from 21,4% to a measly 12,1%. This last result is a direct consequence of my CD8 replicating like crazy... Fasten your seat belts, *drumroll* they've gone up to 2757 (from 500+something, I believe). I didn't have my VL checked this time.
According to my doctor the most likely explanation for this is that my infection is in fact recent, and this would be just my body arming his immune response to the virus. However, with such a low CD4% she has decided to refer me to a hospital, were I will have more blood work done and maybe, start treatment. She's also prescribed me something for thrush, which is strange, cause right now my mouth is feeling ok.
It's curious how the results are (at least at these levels) totally unrelated with how I feel. A month ago, when I had the previous blood draw, I was feeling kind of ill and had a very nasty sore throat. Now I'm feeling perfectly and, however, it doesn't seem to be the case. ;)
I don't know how to feel about this results... I don't really know if it's an improvement over the last ones or quite the opposite... I'm not too worried anyway, I guess I'll have to see what I'm told at the hospital next time.
Hugs!
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Yep, the numbers have changed quite dramatically! And yep, the low CD4 percentage (and also, btw, a highly inverted CD4/CD8 ratio) is the result of cytotoxic overdrive. I'll let the experts parse the meaning -- or meanings -- of this to you. Just wanted to say that your attitude of being informed but not panicked, of wait-and-watch, of being prepared for starting ARVs should you need to -- well, it's quite amazing. You're a helluva of a lot saner and 'sorted' than I am. Here's hoping that the next set of numbers will yield more clarity.
Jay
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Yep, the numbers have changed quite dramatically! And yep, the low CD4 percentage (and also, btw, a highly inverted CD4/CD8 ratio) is the result of cytotoxic overdrive. I'll let the experts parse the meaning -- or meanings -- of this to you. Just wanted to say that your attitude of being informed but not panicked, of wait-and-watch, of being prepared for starting ARVs should you need to -- well, it's quite amazing. You're a helluva of a lot saner and 'sorted' than I am. Here's hoping that the next set of numbers will yield more clarity.
Thanx for your answer, Jay. If you people keep telling me how sanely I'm handling this, at some point I'm gonna start believing you and it'll be your doom. :P
Experts, you heard Jay. Parse the meaning, please! ;)
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I'm not expert enough to parse much further meaning on this particular set of counts. All I can tell you is that you seem to still seem to be on a good upward climb. I'm not super savvy about % stuff.
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I just got an answer from thebody.com interpreting my results:
http://www.thebody.com/Forums/AIDS/Labs/Archive/TCell/Q194025.html (http://www.thebody.com/Forums/AIDS/Labs/Archive/TCell/Q194025.html)
I'm a bit worried, but I guess I can do nothing right now but wait till I get my appointment with the ID specialist in the hospital.
Hugs,
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Hi,
look the signature of others (not mine): the CD4% can bounce
The doc says:
This is concerning if it remains consistent. Although this may be partially due to the numbers fluctuating because of acute infection or the CD8 rise, it can not all be attributed to that.
I'm in the same frog as you, and I have no idea what is the impact of the CD8 in the CD4%.
For my ID doc there is an obvious correlation, for Dr Gallant and others, they don't pay attention to the CD8 and look at the CD4% as it.
My ID doc recommended me to do a blood draw in 1 month to see if my CD4% continue to drop.
If so, he will recommend me to start HAART, no matter the absolute CD4.
Good luck !
John
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Dr. Holodniy's trademark brevity can be wonderful sometimes; other times it makes you want to shake him for being practically robotic.
There's a rough-and-ready correlation between CD4 counts and CD4%, especially for absolute counts <500. So, for example, an AIDS diagnosis is CD4<200 and/or CD4%<14. A CD4 count of 350 would normally be associated with a %age of ~20-22%. As Holodniy indicates in both his responses, your numbers aren't following this pattern. In the first set, the "absolute count is... lowered out of proportion to the CD4%." I.e., a %age of 22 would usually have a higher CD4 absolute count, usually 300+. In the second set, annoyingly, although "the CD4 number doubled the CD4% dropped by half." I'm curious why Holodniy thinks the %age drop cannot entirely be attributed to the CD8 increase -- given that the absolute count there increased more than five-fold, the CD8% must surely have increased dramatically as well, leaving less %age "space" for CD4s. (Or so goes the logic of my non-histologist brain.)
For what it's worth, I came across a "case" with a similar situation, though his wasn't an early/acute infection. CD4s persistently testing ~350, yet %age never above 12%; and CD8s also very high, always 2000+. I did ask Holodniy about this. His response:
http://www.thebody.com/Forums/AIDS/Labs/Current/Q193056.html
This person is now on meds, and his VL is almost undetectable, and the CD4 numbers (about a month ago) are ~440 and 18%. So the percentage is beginning to play catch up.
I do think your next set of numbers (with VL too, I hope!) will provide more clarity. Keep us posted.
Jay
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Yep, I was a little taken aback when I first read Dr. Holodniys's answer... For what it's worth, I still can't make much sense of my numbers, but I guess eventually another set will help interpret them. Anyway, as I feel perfectly fine health-wise right now, and it's just a matter of a couple of weeks till I get more numbers, I'm pretty relaxed about it.
I've thought exactly the same you've written: if lymphocytes = CD4 + CD8 + B cells and the CD8 count increases five-fold, obviously THEN the percentage of lymphocytes that are CD4 goes down the drain. But, the experts are the experts... who are we to disagree ;)
It's comforting to hear the guy in similar situation is doing ok. :)
I'll keep you posted.
Hugs!!
Edit: typo
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Hi
loop78 and lydgate, I got the same discussion as you are having:
http://forums.poz.com/index.php?topic=20963.0
About Dr. Holodniy, I found him providing often either too short or too unclear answers, so I can't conclude anything after reading him. That's personal.
After the point of view of the non-histologist, here is another non-histologist/physicist one:
Mathematically speaking, of course, the CD8 impact the CD4%.
If you know your absolute CD8, CD4 and total leucocytes, you easily compute "the equivalent CD4%" or "relative CD4%" (which is a concept that exists only in my mind -and others maybe, but who have until now no medical meaning as far I know).
The reason why some people are focusing exclusively on the CD4% without consideration of the CD8 is because the CD4% have been part of
many studies and those studies were made most of time without any considerations of the CD8 count.
So without data, no risks are taken interpretating the impact of the CD8 on the CD4%.
If I can understand such safe approach, I also really feel often that we are at the stone age with this disease. Especially because so many basics studies are missing.
For e.g one on this subject !!
I am not an ID doc, neither a biologist nor a HIV/AIDS researcher, but my choice on that (as being in the same situation than loop78) is that as long as :
- I have a high CD8 and CD4 count
- I feel good and no symptoms
- The relative CD4% is ok
- My doctor agree
then I won't pay (too much) attention to the CD4%.
People who do not agree with such approach can be considered as:
- having a "safer" approach
- are going in the direction anyway of many studies that have shows that starting a treatment with high CD4 is good if not better
(but they don't have any proof to contradict the idea that the CD8 is faking the CD4%).
For those who agree:
- at least mathematically there are right
- and if they are right medically (to be still demonstrated), many ltnp/slow progressor might have started their treatment a bit too early or was even ltnp without knowing it
loop78, I would be interested to know your relative CD4%, and especially if they are close to 22% (to compare the relative percentage to the previous "absolute one"
John
edit: correction
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John, this thread is about loop78's lab results, not your highly speculative theories. Your last post was a virtual hijack.
For the record: I have NOT come to the same conclusions as you. In fact, I made no conclusions at all, I am not competent to do so; I merely provided some examples/numbers that I was aware of. I read through the thread you provided a link to; I was at first intrigued, then amused, then dismayed.
It's one think to be skeptical and vigilant and "take ownership" of one's own treatment; it's entirely another to build theories on non-existent foundations. You yourself admit that your mathematical construct "is a concept that exists only in my mind -and others maybe, but who [which] have no medical meaning at all as far I know." To belabor the obvious: mathematical skills, while useful, aren't sufficient to make one a competent HIV pathologist or clinician.
Jay
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For the record: I have NOT come to the same conclusions as you.
"given that the absolute count there increased more than five-fold, the CD8% must surely have increased dramatically as well, leaving less %age "space" for CD4s. (Or so goes the logic of my non-histologist brain.)
I am not concluding neither.
Assuming or hypothesizing, like you no ?
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John, though I appreciate your contribution, I'm gonna have to side with Jay in this. No conclusion at all can be made.
I could calculate what you call "relative CD4%", but it will tell me nothing but what I already know: that, if my CD8 were in the normal range, my CD4% would be also a normal one. The truth, however, is that my CD4% is low, and making up new indicators that contradict that would be deceiving myself.
Regarding your theory, well, I believe it's true that a strong hiv-specific cd8 response has been found in some LTNP. However, that's not the same as a high cd8 count. It's not the quantity, but the kind of cd8.
To sum up, there's no shortcut to this, we have to keep monitoring our results and act accordingly. If in the end the cd8 overdrive turns out to be a good thing, good for us. But trying to back up that theory with scientific data is just wishful thinking. ;)
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I'm questioning, maybe challenging, but only to find an answer.
I don't care at all to be right.
Just want to know the truth.
I realize that there are many theories nothing more, nothing less, but not studies.
So I will rely on a knowledgeable ID doc (even 2-3) and make the conclusion to start meds or not.
it's just a point of view that a exposing here to someone having the same question .
Do what you want with this point of view, you asked for some and you get some.
I don't want to argue anymore on this subject but wishes that all of us will make the best choice!
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I've got no problem whatsoever with that, John, that's why I said I appreciate your contribution.
We're just talking and expressing diverging opinions. That's fine with me.
Take care. :)
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John -- we've warned you before about peddling your theories in these forums. Stop hijacking threads with your theories. If you post in this thread again, you'll be given a Time Out.
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To sum up, there's no shortcut to this, we have to keep monitoring our results and act accordingly
i say amen to that.
on 22 may , i went in to see my doctor at the hospital only to be told that my cd4 is at 299. she wants to do another test in one month time. i did not scream hallelujah, so i said yes (like i got a choice !!) now , i brought her attention to the fact that on the 22 april , i was witness to an attempted burglary to my residence, and one of the burglars came at me with a big screwdriver; he managed to open my mouth and broke a tooth, guess, he was thinking it was the opening to Ali Baba's cave :P Skipping all the details; like how they stitched my mouth up ....................
SHE said no , it is not related ??? , this is viral , she said, i could not even say BITCH as i chose her to look after me !!
i was ready to accept the inevitable and be put on meds. you know after one month of pain , having your mouth poked at ( open bigger ...........failing which they stick a kind of tongs so you stay open , make doing a BJ look like chickenshit) you don't have much strength left.
you used - 2nd - blood work
well , a month later , my cd4 went back up , we are now back to monitor as per normal.
i am not saying , you don't need to worry , i was !! (i had heartforyou and frenchpat members here, as support ) and please don't deny yourself that. and we must each find our own answers. based on what our bodies underwent , it does react different, as i am still going thru' the consequences of this aggression (i will not go into details ) i shall give my body the time it need !!
And Dear loop78 , tomorrow the SUN shine !! Wish you strength and good luck.
Wd