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Author Topic: CD4 fluctuations?  (Read 4435 times)

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Offline lost_boy

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CD4 fluctuations?
« on: April 13, 2011, 06:45:30 PM »
Hi guys,

Just a little sanity check here. I started meds (Atripla) just over 6 months ago in October, when my cd4 ranged between 250-350.

My CD4 in January was around 370 (gone up, hooray!) and my viral load is undetectable.

However, CD4 for April has been 200 - lowest for me so far! My doctor said I shouldn't worry as this is likely a "blip" so I'm having another blood test in a few weeks.

My question is, and I think I am just seeking reassurance here, is it normal for CD4  to vary by a rnage of a hundred or so? I'm guessing meds take a while to kick in and I sort of expected my CD4 to rise and rise before plateauing... my doc said that as we dont know my original CD4, it could actually be at the low end of the spectrum, and it may take a while for it to go up (could it take years?). If so, then I'll know not to be hung up on numbers. The doctor said the important thing was that I am feeling healthy, which I am! Thanks in advance for any insight...

Offline Hellraiser

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Re: CD4 fluctuations?
« Reply #1 on: April 13, 2011, 09:44:39 PM »
If so, then I'll know not to be hung up on numbers. The doctor said the important thing was that I am feeling healthy, which I am! Thanks in advance for any insight...

Your doctor and I agree.  Your numbers are simply an indication of your immune systems general ability to fight off infection.  If you're not sick and your virus is undetectable then your CD4 count is only a glimpse of the state of your immune system.  I know there are a couple of us on these boards running around with lower CD4 counts but we still function fine.

Offline eric48

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Re: CD4 fluctuations?
« Reply #2 on: April 14, 2011, 04:55:31 PM »
For people who are under meds and UD (and adherent) there is no known (*) medical intervention to change (up modulate) the course of immunologic response (CD4 or CD4 %)

(*) known here meaning proven by properly conducted trials. Treatment switch or intensification have repeateadly proven ineffective, as far as I recall. There are a few promising venues being explored, but still a subject of research.

That being said, a significant, temporary count drop without any significant clinical implication is far from rare. CD4 count is the CD4 count in blood, which account only for 2 to 5 % of total circulation, so it is only seeing the top of the iceberg, therefore subject to fluctuations.

if you are young (younger than say, 40-50) the thymus is still active and will produce numerous new, naive CD4s. Not so much if you're 'older', but still ... So CD4 count dynamics may vary a lot between people and more time may be required before you see a strong, solid recovery

Hope this helps

Eric

« Last Edit: April 14, 2011, 05:02:08 PM by eric48 »

Offline buginme2

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Re: CD4 fluctuations?
« Reply #3 on: April 14, 2011, 10:22:47 PM »
My CD4 went down as well after I started Atripla.  It was 410 before I started meds and after 3 months it was down to about 350.  However, the percentage increased.  Do you know what the percentage is?  It tends to be more stable when the absolute count can fluctuate.  I asked my Dr the same question, and he told me as long as I was undetecable the medication is doing what it is supposed to.  I wouldnt worry about it too much.  It should be higher on your next visit. 

Heres to a high cd4!!!!!!!!!!!!!!!!!!
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline hope4love

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Re: CD4 fluctuations?
« Reply #4 on: April 15, 2011, 01:58:41 AM »
I would like to Know what is the normal rate at which CD4 cells are produced per month? A reduction in CD4 can also be due to other infections like cold, fever, dental infections etc.. I have just completed 6 months on "Viraday/Vanovir". Before the start of my medication in Oct 2010 my CD4 was 241 and simultaneously started Viraday, in Feb 2011 my VL was undetectable and CD4 was 361. In 4 months their was an increase of 50% in my CD4 counts i.e 12.5%   increase every month. In April 2011 my CD4 count is 406, in 2 months it increased by 12.5% i.e 6.25% increase per month for the past two months, which when compared to the first 4 months of increase the rate at which it is produced reduced by half. This is not a concern for me but sure has made me wonder why it is not produced as much as it produced in the first 4 months and further need to analyse if it has any influence on diet? exercise? infections? change of drug? etc. I Like to know is their any scientific data available the rate at which CD4 cells are produced in a healthy person with no infections..
Jan 2009 - Sero Negative
Jan 2010 - Sero Positive
               CD4 - 275, VL - 18,000
Oct 2010 - CD4 - 241, Started - Vonavir; Oct 2011 - CD4 - 474;Jan 2012 - CD4-620; Aug 2012-CD4-600, VL- UD; Jan 2013 CD4-493, VL-72 IU/ml   (Blip)

Offline eric48

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Re: CD4 fluctuations?
« Reply #5 on: April 15, 2011, 08:56:39 AM »
Hi,

Like in any complex, regulated system, there are many factors in the equation.

If you would like to keep it simple you would have a calculation with:
- rate of creation of 'brand new' CD4 (naives)
- rate of duplication (expansion) (cells dividing...)
 but the key factor at beginning of treatment is the life expectancy of CD4.

The life expectancy is very different in:
- HIV under active infection (typically 1-2 days)
- HIV starting HAART  (typically 2-4 weeks... - big difference -)
- HIV neg (many more weeks...)

(I am not on the PC where I keep those data at this time, so that is from top of my mind)

Obviously, since the rate of death of CD4 under active infection is so high, the body react by creating a lot of replacements, then will adjust by creating less, once infection is under control.

All this to say that the CD4 population dynamics may show drastic waves (tsunamis...) at beginning of treatment. I, myself, had a drop of 200 at one time...

because there are so many factors, individual, health, time of day, relevance of data, etc., people tend to rely more on % than actual count. Actually, if ones CD4 count is , say, in a safe zone (the definition of which may depend on who you talk to), but you know the usual key numbers 200, 350, 500, and one is maintaining UD, then docs will not care much about the count itself.

Cheers
Eric  
« Last Edit: April 15, 2011, 05:46:01 PM by eric48 »

Offline eric48

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Re: CD4 fluctuations?
« Reply #6 on: April 15, 2011, 05:40:26 PM »
OK ...


these data are coming from here:

http://www.ncbi.nlm.nih.gov/pubmed/9883844

very interesting, but is not a free artcile...

these 2 below are free...:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC25839/?tool=pubmed

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC377453/?tool=pubmed

the later supports the idea that one should allow time ... as it says:

----------
these kinetics [at 12 weeks] did not persist: at later time points (12–36 months) after the initiation of HAART, the fractional replacement and absolute production rates for the CD4+ and the CD8+ T cell subpopulations reverted back toward those observed in HIV-1–seronegative subjects.
---------

so be patient (2-3 years) ... before you even suspect a poor immunologic restoration...

and even if you do... then they don't have a clue what to do... as explained here:

http://www.ncbi.nlm.nih.gov/pubmed/16848276

Hope this helps

Eric





Offline drewm

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Re: CD4 fluctuations?
« Reply #7 on: April 15, 2011, 05:54:53 PM »
Hey lost_boy, just remember that your CD4 count can fluctuate 100 points between morning and afternoon. It's more important to read a trend than it is one or even two lab results. Everything you posted sounds normal at this point in time.  :)
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

Offline lost_boy

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Re: CD4 fluctuations?
« Reply #8 on: April 15, 2011, 06:57:37 PM »
Hey everyone - all your posts have been very reassuring! Just what I needed, I think. Thanks :)

Your doctor and I agree.  Your numbers are simply an indication of your immune systems general ability to fight off infection.  If you're not sick and your virus is undetectable then your CD4 count is only a glimpse of the state of your immune system.  I know there are a couple of us on these boards running around with lower CD4 counts but we still function fine.
Yeah, just need to tell myself that! It's funny when I consider I have some colleagues at work who seem to get struck down by the slightest cold (and I'm pretty certain they don't all have compromised immune systems!!  :P )... I've not had a day off in three years. Well, genuine days off.. there's been times I've been a bit hungover and made a terrible excuse ;)

My CD4 went down as well after I started Atripla.  It was 410 before I started meds and after 3 months it was down to about 350.  However, the percentage increased.  Do you know what the percentage is?  It tends to be more stable when the absolute count can fluctuate.  I asked my Dr the same question, and he told me as long as I was undetecable the medication is doing what it is supposed to.  I wouldnt worry about it too much.  It should be higher on your next visit. 

Heres to a high cd4!!!!!!!!!!!!!!!!!!
I can't remember the percentage off the top of my head, but I know the doctors are happy with it (not to self: really need to get a print out or write them down next visit). So long as I'm undetectable, I'll be happy - that's the most important thing. Incidentally, I think we were both started treatment at around the same time, so it's interesting to see you experience the same cd4 ups and downs. Here's to a high cd4 indeed! :)

... Actually, if ones CD4 count is , say, in a safe zone (the definition of which may depend on who you talk to), but you know the usual key numbers 200, 350, 500, and one is maintaining UD, then docs will not care much about the count itself.

...so be patient (2-3 years) ... before you even suspect a poor immunologic restoration...
Thanks for posting all that data, interesting stuff. Does make me realise I need to look at the long game here rather than fluctuations-per-month.

I can't be the only one who now finds loads of interest in medical reports and how the body functions when previously I had no idea at all? Strangely find myself enjoying learning all this stuff...   :)

Hey lost_boy, just remember that your CD4 count can fluctuate 100 points between morning and afternoon. It's more important to read a trend than it is one or even two lab results. Everything you posted sounds normal at this point in time.  :)
Yeah, the trend was a little down, but then that was only over a couple of months - need to be longer term! Really, thanks again. The italics for emphasis help, it's like a very reassuring voice! ;)

Offline drewm

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Re: CD4 fluctuations?
« Reply #9 on: April 15, 2011, 07:44:43 PM »
I can't be the only one who now finds loads of interest in medical reports and how the body functions when previously I had no idea at all? Strangely find myself enjoying learning all this stuff...

That is an excellent point and you are right on. This virus becomes something of a fascinating study but allow me to caution against reading too much into what's on the web. The folks on this board are a wealth of knowledge especially in the practicality of dealing with HIV/AIDS, meds and social issues...the whole ball of wax. It's important to remember that you hired your doc for a reason and it's important to listen to him/her and ask questions.

 :)
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

Offline lost_boy

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Re: CD4 fluctuations?
« Reply #10 on: April 16, 2011, 07:02:44 PM »
That is an excellent point and you are right on. This virus becomes something of a fascinating study but allow me to caution against reading too much into what's on the web. The folks on this board are a wealth of knowledge especially in the practicality of dealing with HIV/AIDS, meds and social issues...the whole ball of wax. It's important to remember that you hired your doc for a reason and it's important to listen to him/her and ask questions.

 :)

True dat. I should say, I don't spend hours obsessively reading other things on the net! But check one or two websites every other week to see whats new (don't think I'd be normal if I didn't...).

In fact the very first thing my doctors told me after the initial diagnosis was don't go and scare yourself silly reading up on stuff on the web. There's a lot of misinformation/exaggeration/fear mongering out there. Which is why this place is so good - sound balanced opinion and actual experience! Glad I found it. :)

Offline drewm

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Re: CD4 fluctuations?
« Reply #11 on: April 16, 2011, 07:27:09 PM »
Glad you're here and sorry you're here at the same time. In fact, I'm sorry any of us are here under the circumstances.  ;)
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

Online mikeyb39

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Re: CD4 fluctuations?
« Reply #12 on: April 16, 2011, 11:57:03 PM »
my doctor told me the same thing that some folks just always have a lower end CD4 count, its only becasue we are getting it tested now we know the number,  before becoming positive noone ever really tested it.  his concern is the VL number is UD.
11/02/2010  cd4-251, vl-591000
12/09/2010  started Atripla
02/18/2011  cd4-425, vl-800
06/10/2011  cd4-447, vl-70
10/10/2011  cd4-666, vl-80
01/05/2012  swiched med (prezista,norvir ,isentress, )
02/10/2012  cd4-733, vl-UD  Viread removed
06/10/2012  cd4-614, vl-UD
12/14/2012  cd4-764, vl-UD
09/01/2013  cd4-785, vl-UD
03/06/2014. cd4- 1078, VL-UD

Offline drewm

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Re: CD4 fluctuations?
« Reply #13 on: April 17, 2011, 12:34:30 AM »
One other interesting note is I tested positive for Syphilis after my third set of labs but not on the first two. I did not have sex for awhile after my dx so the infection was not new. My doc said that sometimes when our immune system wakes up (his words) it begins to catch these things. If you are sexually active and have not been screened for STD's it would probably be a good idea to make sure they are screening for these. Syphilis is HUGE in Houston so I am glad I had this done.
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

Offline Kabir

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Re: CD4 fluctuations?
« Reply #14 on: April 17, 2011, 05:04:56 AM »
Hi there

Which city u live in India. I am from Delhi and jus tested positive.


Offline Ann

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Re: CD4 fluctuations?
« Reply #15 on: April 17, 2011, 09:13:03 AM »
There's a lot of misinformation/exaggeration/fear mongering out there. Which is why this place is so good - sound balanced opinion and actual experience! Glad I found it. :)

Lost boy, I'm glad you found us too.

And it's not just that this place offers balanced opinion and actual experience, but for example, the Lessons section is written in easy-to-understand English, but they are all based on first-tier, peer-review studies; fact without the scaremongering.

Scientific studies can be difficult to interpret for the ordinary person. We see studies being misinterpreted all the time over in the Am I Infected forum. Thank goodness places like this site exist where people like Tim Horn and David Evans act as translators. And even ordinary members like Matt the Newt who has the skills to interpret the studies correctly.
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Offline eric48

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Re: CD4 fluctuations?
« Reply #16 on: April 17, 2011, 05:49:47 PM »
Thanks for posting all that data [...] Strangely find myself enjoying learning all this stuff...   :)


You're welcome... Same feeling here.

Strangely enough, I have been attracted by the subject "why do some people are not getting enough immunologic response despite good virologic response"

(strange because this is a problem I do not face, as of today,... - nor do you BTW)

But some people do have this discordant response.

I believe there is a key (not yet identified) to that problem and , IMHO, the key is most likely in a better understanding of the CD4 dynamics .

the 2 parameters of importance in the dynamics are:
- rate of creation of CD4s
- life expectancy of the CD4s

and their life expectancy is dominated by 2 factors
- their genetic/DNA/natural life expectancy
and
- them being killed (un natural life termination)

If I were younger and free of my family support needs, I would take a different path in career and would like to work in research (again), and that would be the field I'd be willing to explore

Strangely find myself enjoying learning all this stuff...

Eric


Offline RichardfromIndy

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Re: CD4 fluctuations?
« Reply #17 on: May 16, 2011, 10:16:48 PM »
My experience has been that fluctuation in my cd4 count isn't that big of a deal even if there is a hundred point difference.  It normally will stay within range over an extended period of time.  The fact that there is no exact standard for a person's cd4 count it is best to go by what you are averaging over time.  Some people may have a tendency to have a lower cd4 count while others may have a higher count.  Since cd4 count is not usually a normal test, most people don't know what their count was prior to contracting hiv.  For me, the important thing is tracking it so that I can be proactive if it seems to me that it is dropping precipitously.  My lowest count was in the 250 range and I was beginning to really get concerned.  The change in medication brought it back up in the 625-725 range and that has been where I have stayed for the past several years.  Again, for me it is just being aware of my health status and doing what needs to be done.  For a period of time I was concerned that I was going into the "wasting" mode and I forced myself to eat properly and eventually got thru it.  I am currently on a low-carb diet and exercise 3X a week.  Doing this helps me emotionally and physically.

 


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