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Author Topic: Why CD4s may not recover even after virus is undetectable  (Read 2802 times)

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Offline allanq

  • Member
  • Posts: 689
  • still life with pills
Why CD4s may not recover even after virus is undetectable
« on: September 18, 2008, 01:55:00 PM »
I sometimes see reports on this forum from people whose CD4s were very low before they found a successful regimen. Then their CD4s shoot up to 500 or 700 or even higher. I've always wondered why mine seem to languish around 200, even though my VL has been undetectable for several years. Explanations from my doctor and various online experts never really shed any light on this. I've been told that the reason my CD4s are still quite low is that I started with a very low CD4 count. But the experience of others tells me that there is more to it than that.

I finally found what seems to be a reasonable explanation for this phenomenon. It has to do with scarring of the lymph nodes. Here is an abstract of the article that appeared in the Journal of Infectious Disease.

http://www.physorg.com/news137168160.html
Top (Breakfast): Prezista, Norvir, Isentress, Zoloft (2), Glyburide (2), Aspirin
Bottom right (Dinner): Prezista, Norvir, Isentress
Bottom left (Bedtime): Sustiva, Trazodone (2), Lipitor, Septra (no longer taking this)
Center: Alprazolam (Xanax)
Not shown: various vitamins & supplements

Offline SteveA

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  • Posts: 174
Re: Why CD4s may not recover even after virus is undetectable
« Reply #1 on: September 18, 2008, 01:59:44 PM »
Wow that's excellent! I'm going to mention Anti-fibrotics to my doctor and see what he has to say. My T-Cells have been hovering in the 400 range since I became undetectible two years ago. Now I know why.

Offline allanq

  • Member
  • Posts: 689
  • still life with pills
Re: Why CD4s may not recover even after virus is undetectable
« Reply #2 on: September 18, 2008, 06:33:46 PM »
Steve,

A CD4 count of 400 doesn't sound too shabby to me. Maybe that's because I've been around 200 for so long.

With some labs, 400 is considered in the "normal" range. I use Lab Corp. Their normal range for CD4s is 359-1519. (I wonder how they arrived at those numbers.)

Allan
Top (Breakfast): Prezista, Norvir, Isentress, Zoloft (2), Glyburide (2), Aspirin
Bottom right (Dinner): Prezista, Norvir, Isentress
Bottom left (Bedtime): Sustiva, Trazodone (2), Lipitor, Septra (no longer taking this)
Center: Alprazolam (Xanax)
Not shown: various vitamins & supplements

Offline SteveA

  • Member
  • Posts: 174
Re: Why CD4s may not recover even after virus is undetectable
« Reply #3 on: September 19, 2008, 03:14:45 AM »
Well low normal the last time I really read up on them. They're not too shabby, but of course I'd like to see them better if it's possible.

Offline leatherman

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  • Posts: 6,272
  • Google and HIV meds are Your Friends
Re: Why CD4s may not recover even after virus is undetectable
« Reply #4 on: September 19, 2008, 10:56:16 AM »
That is interesting. I too have wondered why my tcells never recovered much.

The first labs I remember are from 98 when I was in the hospital with PCP and my tcells were 34. Ten years later, and 47 labs later, my tcells have only gone as high as 311 and the avg has been 224. (latest labs I just got yesterday, the tcells "jumped" from 214 to 256! Woohoo). Because of two bouts of pneumonia and staying so close to 200, I've stayed on bactrim all these years.

I have to admit my low tcells do cause me to be slightly germaphobic. Someone sneezing in a store has caused me to leave in a panic before. For several years after my two hospitalizations, I stayed in my house most of the time, living like a hermit. (That was a tough mindset to break ;) ) Thankfully, though they've stayed this low (and perhaps this report has the explanation why), my little batch of tcells have been working well and I haven't been in the hospital again, or had the flu or a cold in all these years.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Finnboy

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  • Posts: 73
Re: Why CD4s may not recover even after virus is undetectable
« Reply #5 on: September 19, 2008, 11:37:40 AM »
With some labs, 400 is considered in the "normal" range. I use Lab Corp. Their normal range for CD4s is 359-1519. (I wonder how they arrived at those numbers.)

The reference range will vary by age, sex and race of a population. The range used by a laboroatory generally covers the values that will be returned by 95% of the healthy population - and so, by definition, 5% of the healthy population will have a value which is above or below the range - but with a measure like CD4, it naturally decays with age anyway. Therefore a range used by a laboratory in an area with more older people could easily be lower than the national (or even international) range.

This is one reason I would never dream of referring to my CD4 count, because in truth it only reflects my personal trend from my personal starting point. It is a meaningless (and possibly even demoralising) comparison for someone whose natural, uninfected and perfectly healthy CD4 count would only have been 400.
« Last Edit: September 19, 2008, 11:45:14 AM by Finnboy »

Offline bocker3

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  • Posts: 3,421
  • You gotta enjoy life......
Re: Why CD4s may not recover even after virus is undetectable
« Reply #6 on: September 19, 2008, 05:51:04 PM »
The reference range will vary by age, sex and race of a population. The range used by a laboroatory generally covers the values that will be returned by 95% of the healthy population - and so, by definition, 5% of the healthy population will have a value which is above or below the range - but with a measure like CD4, it naturally decays with age anyway. Therefore a range used by a laboratory in an area with more older people could easily be lower than the national (or even international) range.

This is one reason I would never dream of referring to my CD4 count, because in truth it only reflects my personal trend from my personal starting point. It is a meaningless (and possibly even demoralising) comparison for someone whose natural, uninfected and perfectly healthy CD4 count would only have been 400.
I think it is extremely important to note that a reference range (note:  I did not say "NORMAL RANGE") is only a guidepost.  As Finn points out -- about 5% of a population may have a "normal" result (that is normal for them) outside this range.  Although it is not true that all reference ranges vary by sex, race or age -- many do, but not all.  Additionally a reference range usually is representative of a lab's general population, not the world as a whole.  For example, if you live in Denver, the reference ranges for things like RBC and HGB will be higher than for a population at sea level due to the differences in oxygen levels. 
So if you live in NYC and have a blood count in Denver you might have a number of lab results listed as "out of the reference range" but that doesn't mean any action is needed. 
One should always evaluate lab results in a holistic manner.  What is "normal" for one person may be quite problematic for someone else.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline SteveA

  • Member
  • Posts: 174
Re: Why CD4s may not recover even after virus is undetectable
« Reply #7 on: September 19, 2008, 08:17:48 PM »
Well the only reason I mentioned my 400 range t-cells as what I considered low is when I came down with MAC in 97 I only had 6 T-Cells. When they started me on combo therapy, my T-Cells got up to the 600+ range. Then I had my midlife party crisis and stopped meds for about two years til they dropped to 200 and my Doctor put me back on meds. Even though my VL never was undetectable when I had the higher T-Cell counts, now with an undetectable VL it's not as high as it was back then. I guess my age and that med vacation are working against me now.

 


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