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Undetectable with Declining CD4s -- Any Guidance?

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PFOUR2013:
Hi Eric,

Thanks for all of your input -- thought I must admit I don't fully understand all of the math and decay discussion mentioned in your first post.  Have there been studies showing this?  Admittedly I haven't read much research at all but this isn't something I have come across.  Any additional info you have would be appreciated  :)

I went back for my follow-up with the doc after starting Epzicom.  So far no major issues.  He said it was likely still to early to see a difference (only been 2.5 weeks), but he did want to run my labs again to determine whether I should start taking Bactrim for the short term as well.  CD4 came back at 152 (33%) so largely no difference.  Hopefully this is my plateau point and things will increase from here.  I'll have another set drawn in 1-2 months to check again.

1in1000000:

--- Quote ---Managing immunologic and clinical failures

Most immunologic failure follows virologic failure. The opposite situation where viral load is suppressed but the CD4 count fails to rise sometimes occurs. It is important to rule out laboratory and clerical error in processing the blood samples. Certain non-B subtypes are not accurately measured by the earlier generation of assays and alternative methodologies may need to be considered. Intercurrent illness and opportunistic infections may depress the CD4 count and have to be ruled out. Tenofovir (TDF) + didanosine (ddI) as a backbone of HAART is also known to have a negative impact on immunologic recovery.

In most cases, the phenomenon cannot be explained. Watchful follow-up is probably the only recourse while prophylactic treatment according to usual thresholds will have to observed. Most of these patients do well. Specific immunologic treatment such as IL-2 could be considered, but is overall clinical impact is unknown. Recently, certain antiretroviral combinations were found to be associated with a better immunologic recovery than others.13,14 Its relevance to this situation, however, is unclear.

On the other hand, immune reconstitution disease occasionally occurs in patients who have apparently responded to HAART, and yet deteriorates clinically (see Chapter 15). Immune reconstitution disease is not regarded as 'clinical' failure. It requires specific treatment and sometimes non-steroidal anti-inflammatory drugs and systemic steroids for symptomatic control. HAART is generally continued unless life-threatening disease occurs. True clinical failure develops rarely with virologic success and immunologic response. However, there is evidence that certain HIV-related complications are developing at higher CD4 strata in the HAART era. This is probably related to the fact that immunologic recovery from HIV-mediated damage is not complete despite viral suppression.
--- End quote ---



http://www.info.gov.hk/aids/pdf/g190htm/12.htm

1in1000000:
There is some evidence that thymus can be stimulated by the growth hormone.
You can ask you doctor.

eric48:
If you have CD4 around 200 and % around 33% it means your total lymphocyte is around 600... This is low. The 'normal range' is : 1000 to 4000. mine are around 2000

Immunologic failure iss when total lymphocyte is normal and CD4 fails to go up.

have a look at your total lymphocyte before treatment, that may give you a hint.

More over lower than range lymphocyte may not be so much of a problem. only 2 to 5 % of total lymphocyte get out of lymph system into the blood. So you may still have a low % going into blood while having a normal quantity of lymphocites in the entire body.

the 33% is a good sign. what is your CD4/C8 ratio (or CD8%, if you wish) ?

Eric

newt:
Agree with Eric - matt

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