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Author Topic: CD4 Is this as good as it gets?  (Read 3830 times)

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Offline bmancanfly

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CD4 Is this as good as it gets?
« on: September 10, 2011, 12:47:03 PM »
I've been on meds now for more than 3 1/2 years (Viramune/Truvada)  and my CD4 count seems to have plateaued in the lows 400's  (most recently 405). 

My pre-meds CD4 count was always in 240-390 range,  almost always in the mid 300's with only an occasion outlier here and there, over a 5-6 year period. 

I've read here that maintaining a CD4 count about 500 is important for a good long term prognosis and I'm concerned.

Should I expect any improvement at this point or is this as good as it gets for me?

I vaguely remember some study being conducted to help people on meds whose CD4 count hadn't responded much,  like mine,  but I don't remember the specifics.  Anyone remember what it was?

I've been undetectable the whole time I've been on meds.
"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Online Miss Philicia

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Re: CD4 Is this as good as it gets?
« Reply #1 on: September 10, 2011, 01:26:43 PM »
It's not unusual to plateau like you have after 3-4 years on treatment. The same thing happened to me, and I began treatment with lower numbers than you did. So my numbers climbed then plateaued in the 300-450 range for another 4 years, then magically began to climb again. Then they plateaued again for another few years, but still higher numbers. Then yet again they began to rise -- I've now been +1000 consistently for 4 years.

You're out of the "worry" zone for opportunistic infections generally. You're fine.
"Iíve slept with enough men to know that Iím not gay"

Offline leatherman

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Re: CD4 Is this as good as it gets?
« Reply #2 on: September 10, 2011, 01:38:16 PM »
after 19 yrs of sickness and meds and very low cd4 counts, mine have plateaued around 245. Oh, I've bumped up to 300 a couple of times but haven't been able to sustain that. A study done showed that people who hit a very low nadir often take a longer time to recover and recover less.

While many people here have recovered a great deal (even when it's taken years), there are still quite a few who have never seen much of a "recovery" but have not suffered ill effects because of a low count. Recovery of cd4s is a very individualized issue (most people don't even know their PRE-HIV counts so they have no comparison of what level they should even hope to recover to) and there's really nothing that one can do to influence that recovery.

My 245-level has kept me out of the hospital for 13 yrs, with only 2 fevers, 1 cold, and 0 flu - which just goes to show that it's not how many cd4s that you have but how well they work. ;)

If 400 (which is well away from the 200/AIDS level) is keeping your healthy, then you really shouldn't be concerned much about this issue. ;)
leatherman (aka mIkIE)


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

Offline newt

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Re: CD4 Is this as good as it gets?
« Reply #3 on: September 10, 2011, 01:40:52 PM »
The answer is no, not necessarily. Give it 6-7 years then judge. Both the experiences noted above are typical.

- matt
"The object is to be a well patient, not a good patient"

Online Miss Philicia

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Re: CD4 Is this as good as it gets?
« Reply #4 on: September 10, 2011, 01:44:25 PM »
Yes, I should add that I also know plenty of people who, like Mikie, somewhat permanently plateau. And/or if they move on from the plateau it's only a moderate increase of +50-100 cd4 and then plateau at that point. So overall it's very, very feasible that one must makes themselves comfortable with the idea.

Also, IMO there's not much practical difference between how I personally feel with +1000 counts and ~500. It's all just some numbers on a piece of paper. Maybe when I get a cold it lasts a day or two less but that's about it. I've had more than 1 cold and 0 flu even with much higher numbers than Mikie. Like annual or at least every other year upper respiratory infections (which I always have gotten since being a kid), and yes I even managed to get that filthy swine flu when it was passed around a couple of years ago.
« Last Edit: September 10, 2011, 01:46:48 PM by Miss Philicia »
"Iíve slept with enough men to know that Iím not gay"

Offline bmancanfly

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Re: CD4 Is this as good as it gets?
« Reply #5 on: September 10, 2011, 02:38:05 PM »
Thanks for the replies guys.

It's good to know that a plateau isn't necessarily permanent.  I guess I'll just have to be patient and see what happens.
"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline elf

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Re: CD4 Is this as good as it gets?
« Reply #6 on: September 13, 2011, 08:10:59 AM »
You didn't say what your CD4% was.
My CD4 jumped from 353 to 510 and then to 1200 in a year,
but my CD4% needed 3 years to reach the normal value (33%),
and still there's room for improvement.

Selenium+zinc+melatonin+calcium+vitamin D seem to be helping me.

Sometimes a change of medication is needed.
My CD4% was stuck at 18% for two years (on Kaletra and Combivir), and only after I started Kivexa/Epzicom
it started going up.
« Last Edit: September 13, 2011, 08:24:49 AM by elf »
Let's have a Kiki!

Offline bmancanfly

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Re: CD4 Is this as good as it gets?
« Reply #7 on: September 13, 2011, 09:50:21 AM »
I'm going to see my doc today.  I'll see what he says about the possibilty of a med change and whether he thinks that will help any.   I'm not sure I understand why it would,  but he's the doc.
"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline SoSadTooBad

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Re: CD4 Is this as good as it gets?
« Reply #8 on: September 13, 2011, 04:39:21 PM »
Bman, it took me 6 years to get from a count of 78 to a count of 505.   And, I had a plateau around 400 for about 4 years of that time.  I think you could reasonably expect additional improvement along the lines that have been described here - but even without it, you'd be best advised to enjoy life and continue to take good care of yourself.

Hope your doctor visit went well.

Offline eric48

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Re: CD4 Is this as good as it gets?
« Reply #9 on: September 13, 2011, 06:36:48 PM »
Would be hard to make a long story short, but you may find good graphical explanation on the internet. I remember some good ppt presentation.

If you think of your CD4 absolute count as of a population, it results from dynamics and constraints.

A (positive) dynamics:
- they are created by:
+ generation in the thymus (if you still have one and if it is still functional - older people (>50) typically do not have a thymus any longer, same with people whose thymus got exhausted for other reason)
+ bone marrow stem cells (small contribution, but constant, see the Berlin patent's)
+ 'expansion' (they divide to create clones)

B (negative) dynamics:
- they 'die':
1 - of they own accord (natural life expectancy)
2 - of being targeted because they are identified as carrying a virus
3 - as bystander to general inflammation (this is the main process, some article say 95% ; the usual marker is the ratio CD4/CD8)

Taking HAART will significantly reduce 2 and 3 (albeit with dynamics that may depend on people)

C Constraints:
your body also produces other types of lymphocytes (e.g. CD8 and NK) which take their own 'space' (or percentage, if you will)

On some people the choice of HAART may be a bit more favorable on 2 and 3. But, since Combo A might work better on patient X while combo B might work better on patient Y, there is no smoking gun that one combo works better than another (when looking at it from a bird eye statistical view)

(If there was, you can be sure the manufacturer would advertise it big time)

So far intensification trials have not yielded significant difference.

While you may be right that, at the statistical level, being UD and over 500 is marginally beneficial (especially for males), you can not ignore that there is also diversity within the CD4 pool and that helps explain why some people's health, while on a 'lower' CD4 count strata, can be better than that of some in the higher counts.

if you like FUNNY, yet serious reading, do not miss:

CD4saurus Rex & HIVelociraptor vs. development of clinically useful
immunological markers: a Jurassic tale of frozen evolution.

http://www.translational-medicine.com/content/pdf/1479-5876-9-93.pdf

It is well documented, entertaining and helps put in perspective the classical strata <200; <350; <500; > 500

Hope this helps

Eric

Offline monkeyman65

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Re: CD4 Is this as good as it gets?
« Reply #10 on: September 15, 2011, 05:38:16 AM »
When you've had your diagnoses as long as I have(27+yrs)you learn how to deal with the roller coaster feelings :-\Just keep taking the Meds and try to stay healthy as much as you are able. I know slot of people say that "things will get better"but sometimes you have to be the one to make them that way. :)Hang in there brother and keep the faith!
M.M.65

 


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