High T cell Vs Low T cell with UNdectable Viral Load

[pinkadam]

what is the difference between two people one with High Tcell (> 500) count and other with Low T cell (100-200)count when the viral load is undetectable in both of them assuming both of them on the HAART.

My doctor thinks as long Viral load is undectable , you are safe. T cell count does not play big role when the Viral load is undectable.

I would like to know if he is right. Do i have to see a different doctor

I follow this forum very closely and i have hard time believing my doctor

[whizzer]

Most physicians use the CD4 counts as a barometer of when to consider starting medications.  Once meds have been started, then controlling the viremia, measured by the viral load, becomes the major concern.  CD4 counts tend to take a back seat.  Why?  Well,  the lower the viral load while on meds, the less viral replication is taking place, which means there is less of a likelihood for mutations to occur that might lead to resistance.

Low CD4 counts are a concern with regard to opportunistic infections.  The uncontrolled HIV infection itself is responsible for other of the more insidious aspects of this disease.  Which is another reason your doctor wants to get your viral load as low as possible, and keep it there as long as possible.

When the viral load is undetectable, the CD4 counts tend to rise over time on their own.  Very slowly for some, more rapidly in others.  In any case, the doctor can't make new CD4s for you, so controlling the HIV infection is really the only recourse.

BUT.......  in your example, you compare someone with 100-200 CD4s to someone with 500.  Below 200 CD4s, that individual should be placed on prophylaxis for PCP, and is more at risk for opportunistic infections.  So if your CD4s are below 200, your doctor should still be worried about your CD4 count, as well as your viral load.  Above 200, then the doctor will be more concerned with maintaining maximum suppression of your viral load.

That's my take on it, anyways.

-Whiz

[pinkadam]

Thank you Whiz.
I started my medication when my Tcell was 57 Viral load 70K  on SEP28 2006. My T cell went up to 190 and my viral load dropped to undetectable in two months. I experienced very bad cold in Jan 2007 for couple of weeks and my Dr gave me a flu shot and my Tcells dropped to 150 and Viral was undectable.

Though my T cell count is 150 my Dr thinks iam fine and i really dont need to be on Prophalaxis. He thinks iam very paranoid as i tend to get stressed out for minor fever and run to him for help.

I would like to know if any one here not on Prophalaxis when their T cell is below 200  and Viral load undetectable.

THx
Pink

[Central79]

Hey - you are showing a strong recovery, but you should be on PCP prophylaxis with a count less than 200-250 cells/mm3. You should certainly have been on prophylaxis in the past with a CD4 of 57 - agains MAI, CMV, histoplasmosis, and toxoplasmosis - when you were wide open to these things.

I would suggest that if you haven't been on prophylaxis in the past, then your doctor has been pretty negligent in his treatment of you. I would also argue that not being on prophylaxis with a CD4 of 150 is not great medicine either. Personally, I want my doctors to be aggressive in maintaining my health. It sounds like you do too!

You might find this article useful:

http://www.aidsmap.com/cms1032007.asp

And if I were you, I would google your doctor and find out what his qualifications are. Is he an HIV specialist? Is he a member of your country's HIV association?

Matt.

[pinkadam]

Matt

Thank you for your article. The articale kind of supports what my doctor belives.
It says you can stop prophylaxis if your Tcell rose 100 in 3 to 5 month period and also it says to put the patients on prophylaxis when the T cell count is less than 150 when you are on HAART.

I was on prophylaxis before i started HAART in SEP2006. My doctor stopped it after i was undectable and my T cell count went above 150.

I may have to be  careful and keep an eye on my Tcell count  until i reach a stable count.

thx
Pink

[Central79]

We're talking about PCP prophylaxis now, right? The others you can stop earlier, but you're still susceptible to PCP at counts upto 200, which is the generally agreed point at which to stop. And I wouldn't be in too much of a hurry even then.

Where'd you read that bit about T-cells rising 100 in a 3-5 month period? I can't see that in the PCP section...

Anyway, your call - I hear that PCP prophylaxis isn't all that nice.

M.

[BlkRedBonenla]

Funny someone beat me to this, as I was about to post a very similar question.

I just got my very first lab results back since starting atripla. My cd4 had been 78 and VL 50,000. I started atripla almost exactly one month ago.

The current lab results indicate my cd4 has risen only to 81 but my VL is undetectable.
My doctor at UCLA says I will stay on the Bactrim prophylaxis until I have gotten a cd4 of 200 and maintained it for 6 months.

When mmy cd4 was measured last year it was 73, and I turned - as I always do - to alternative therapies, in this case st john's wort and licorice root. The result of that was my cd4 rose to 78, which the doctor boo-hooed as an insignificant change.

[bimazek]

i agree with all mostly people wrote above

but would like to add...  cd4 count is like a beach ball that is balancing on the water spraying out of a fountain, it goes up and down, and such, or above a fan vertically, the fountain is the body creating new cd4 cells every day

the ball is going to go up and down on its own in a narrow or wider range depending on many life factors,

the immune system itself is a non linear system look it up on wikipedia, means it is incredibly complex, so complex perhaps no human can even imagine all the parts simultaneously, so over simplified models explain but make things over simplified

for example, the nef protein which is not even measured seems to be doing all the damage in the body or much of it with out nef protein in body none of the diseases happen

a mutant hiv virus that does not produce nef causes no disease,

yes nef is parallel to VL to lower cd4 cells but it is complex

nef is hard to measure, expensive, test not easy

also

it is the homing signal that kills the cd4 not the infected cells, this was just discovered a few months ago

uninfected cd4s get a chemical signal to self distruct because the body thinks the infection is taken care of on a daily basis and puts away the soldiers and tells them to self distruct, but the virus is a trojan horse and is hidding in the immune system itself which confuses the immune system

over time the immune system is very compromised

i like to think of the body or immune system as NYC

an incredibly complex system

then the cd4 cells are yellow cabs

sometimes there are more some times less

count the ones in the blood, the roads the streets

but that does not say how many are in the park in the central park the lungs

or what they are doing

some are full of hiv

some yellow cabs are full of hiv

but only one in one million are full of hiv infected

even if your cd4 count is high or low there are very few that are infected

but the body keeps saying... chemically the convention is over, go back to the garage and get repaired get gas

the CD8 cells .... hiv specific cd8 cells are suppose to and they do eat up all the virus and infected cells in cats, hyenas and apes, and thier cd8 cells take care of this little tiny  unimportant virus...

in LTNP long term non progressors the cd8 cell... and this was just discovered at univ. of beijing 2 weeks ago ... all of them have CD8 cells that do not get turned off by a chemical signal

98% of us have a switch on our cd8 cell that gets chemically changed that causes the hiv specific cd8 killer cells to get disfunctional

now they are working on how to turn the switch the other way

try a search on

my user name

bimazek and

CD8

as the key word