Understanding blood test results and trends

[forrest]

Hi all,

I hope this is the appropriate forum to post this in.

I am wondering if someone can help me to understand the numbers from blood tests.  My doctor has explained it to me twice now and I am just not remembering/grasping it.  I understand the ranges and what VL, CD4, etc. mean. I am struggling with the whole trend...

I was expecting that if my CD4 went down, my VL would also go down.  However, my CD4 has remained pretty much the same but my VL keeps on going down.  And with the latest results today, didn't they also change logs?  Since I went from the 10,000 - 99,000 range to less than 10,000? 

While I consider myself intelligent... please feel free to dumb up your response for me!!     Cuz, I'm just not getting it... and please be patient with me while I try to "get it"   

You can see my latest numbers in my profile.  Just not trending the way I would expect so trying to understand    Thanks as always!!!

[leatherman]

after an initial rise in viral load (VL) after infection, the vl drops and levels out for quite some time. At some point in time, the VL will begin to rise. As the HIV utilizies and destroys the immune system, the cd4 count will begin to fall. (that's VL rising and CD4 falling, which is not what you stated).



some people are long term slow progressors, whose body is basically able to keep HIV in check for numerous year. Although it's too soon tell if that's your case, your viral load has been dropping (that's a trend) while your tcells have held steady (another trend because there are 3 or more result.). CD4s can change by 100 in a day, so 480-580 (even 603) is all basically the same. So you're numbers might not be trending the way you expected but they are trending in a good direction, so be glad about that.

[spacebarsux]

Seems to me your body has got a fairly good handle on the virus. Your CD4 (absolute number as well as the percentage) are within normal range and your viral load seems to have reduced.

Here is some more information as to how viral load tests work:

Viral load tests multiply virus found in a small sample of blood many times so that it can be counted more easily. But this means that the individual results from any one test are not very accurate.

Viral load tests can have a 3-fold margin of error. So, if your viral load result is 30,000, the real result could be anywhere between 10,000 and 90,000 copies/mL.

•Viral load tests are described by the lowest level of HIV they can measure – or how sensitive the tests are. Different tests can measure different minimum levels of HIV.
•The main cut-off limit for viral load tests is less than 50 copies/mL. Some tests can measure lower levels (ie less than 5 copies/mL) but these are only used in research.
Using viral load and CD4 count to monitor HIV
Used together, CD4 counts and viral load results will tell a doctor 95% of what they need to know about the risk to your health from HIV and how well your treatment is working.

Viral load test results can be used together with CD4 counts to monitor HIV infection. As with CD4 counts, it is important to look at the trend of viral load over several tests to get a picture of whether there is any change.

•Never make any treatment decision based on the result of one test.
•When using HIV treatment, viral load is important, not CD4 count, because not getting viral load below 50 copies/mL will limit how long treatment will work.
Viral load tests are used in many countries but are difficult to get in others.

Link: http://i-base.info/ttfa/section-2/28-what-is-a-viral-load-test

[forrest]

ThanksLeathermanandSpacebarsux!

I understand the overall blood tests... but at a couple of my doctor visits, my doctor explained exactly what was going on in regards to the replication of the HIV, etc. and how (why) the VL was actually going down while my CD4 wasn't going down much.  There was a reason for that where he drew it out (on the paper that is on the bed thingy in the room) but I just can't seem to grasp.  Like I said, I am sorry that this one is more difficult for me to grasp and again appreciate the patience.  I'm looking for more of the why the CD4 stays about the same but the viral load continues to go down and down. I'll be asking again next week at my appt (however, won't be with the one who has explained it to me before so fingers crossed  ) 

I'm not asking probably as clearly as I should be either.  That is another topic.  It seems like my brain just does not function well at all this past year. I have really been struggling with memory and comprehension - I do not know if it's HIV related or what but it's driving me crazy.  Anyway, that is a whole other topic I realize. 

Thanks again.

[forrest]

Hmm. I just found this document on the Project Inform site.  I am going to read through it. Looks like it has a lot of information in it - all in one location.  Not sure if it will talk about the "trending" - but good info none-the-less 

www.projectinform.org/pdf/bloodwork.pdf

[forrest]

Thanks to Leatherman... I wanted to share some additional thoughts he gave me that may help others on understanding.  This particular explanation for some reason clicked with me so maybe it will help others as well:

HIV initially enters your system. Your body mounts an attack by raising the level of cd4 cells to attack the virus. The virus co-opts the cd4 cells making more virus, while killing off these extra cd4s. The body continues to fight back. (and this is why the western blot verifies a positive reaction to HIV antibodies and a person is declared "positive") So at first there is a serious rise in viral load.

After a while though, the HIV destroys enough of the cd4s that the HIV runs out of fuel so the viral load begins to fall until an unhappy balance is reached. The leveled-off situation can now continue for months or years - it all depends on a person's genetics, immune system, and how much the initial infection destroyed of a body's defenses. After some time, HIV begins to slowly replicate again. However, the antibody response is usually slow to react to this gradual act. Within a short amount of time HIV is able to overwhelm all of the body's defenses and begins to destroy the host (this is where an AIDS condition is reached). Eventually death follows.