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Author Topic: What exactly is the definition of a suppressed immune system?  (Read 1992 times)

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Offline Newguy

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What exactly is the definition of a suppressed immune system?
« on: August 25, 2013, 09:42:41 PM »
Hi all

Driving me crazy with this definition. I read sometimes "HIV positive people with a suppressed immune system" I have HIV but is my immune system suppressed? I am on treatment and my CD4 is well over 500.


Offline jkinatl2

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Re: What exactly is the definition of a suppressed immune system?
« Reply #1 on: August 25, 2013, 10:01:11 PM »
Hi all

Driving me crazy with this definition. I read sometimes "HIV positive people with a suppressed immune system" I have HIV but is my immune system suppressed? I am on treatment and my CD4 is well over 500.



Arguably yours is not, but at least in determining immune health, my clinic uses the lowest recorded CD4 count to determine whether a person should take the precautions aimed at "suppresed Immune System" folks. So in that case I will likely always qualify.

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Offline Ann

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Re: What exactly is the definition of a suppressed immune system?
« Reply #2 on: August 26, 2013, 05:13:16 AM »
Generally speaking, a "suppressed immune system" due to hiv is when the CD4s are under 200 - the threshold under which a person should be on antibiotic prophylaxis to prevent certain OIs, such as PCP pneumonia.
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Offline Rhaegar

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Re: What exactly is the definition of a suppressed immune system?
« Reply #3 on: August 26, 2013, 07:16:10 AM »
Arguably yours is not, but at least in determining immune health, my clinic uses the lowest recorded CD4 count to determine whether a person should take the precautions aimed at "suppresed Immune System" folks. So in that case I will likely always qualify.

So, even if your CD4 count improves to a presumably normal level they would still keep you on prophylactic medications?
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Offline Ann

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Re: What exactly is the definition of a suppressed immune system?
« Reply #4 on: August 26, 2013, 07:30:57 AM »
So, even if your CD4 count improves to a presumably normal level they would still keep you on prophylactic medications?

A person can normally go off antibiotic prophylaxis when they've had CD4s over 200 (some doctors prefer 250) for at least six months to a year, again depending on the doctor and also the patient. A patient who actually had an OI while their CD4s were low might be kept on the prophylaxis for longer than one who didn't.

Most treatment guidelines are "rule-of-thumb" and not really a one-size-fits-all rule - hence being called "guidelines" and not "rules". Each patient's individual circumstances (including living circumstances) and health history needs to be taken into consideration when treatment issues are being decided.
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline newt

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Re: What exactly is the definition of a suppressed immune system?
« Reply #5 on: August 29, 2013, 09:03:56 AM »
Quote
Generally speaking, a "suppressed immune system" due to hiv is when the CD4s are under 200

I disagree, it means either (1) under 350, or (2) under 500 or (3) under normal range for you location (400-500).

In the context of immunisation advice, it may mean under 200, but this is probably because the guidelines/evidence used is older.

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Offline moxieinme

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Re: What exactly is the definition of a suppressed immune system?
« Reply #6 on: August 29, 2013, 10:16:17 AM »
My understanding was that a compromised immune system was defined by NIH standards as one or more of the following:
1) A CD4 count below 350
2) A CD4 percentage below 14
3) A detectable viral load

When your CD4 count is 350 cells/mm3 or less, itís time to consider treatment. A CD4 count of fewer than 200 cells/mm3 is one of the qualifications for a diagnosis of AIDS.

I agree that the nadir (lowest) CD4 count recorded for a person dictates how much leeway they have in things like treatment interruptions. For someone like me, who has had an OI and CD4s in the double digits, a treatment break is not an option.

But I'm also really curious about CD4 percentages, and just asked a friend about this recently. It's one of the AIDS-defining factors but I hear so little about it from people. I've had low percentages, but fortunately they're creeping up. What are people's experiences with CD4 percentages vs. actual CD4s and viral loads? Is this truly another indicator of immune system health?
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CD4 at diagnosis 1989 = 330
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Offline aaware72

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Re: What exactly is the definition of a suppressed immune system?
« Reply #7 on: August 29, 2013, 10:20:20 AM »
I agree I been told different answer to this question.  How it was explained to me  is that years ago if someones CD4 cell were below 200 you then had AIDS if it was over 200 you had HIV.  My ID doctor tells me this is no longer used.  However when I was first found out I was positive my CD4 count was 230 and my ID did not want to give me any vaccination until my CD4 was up over 400 over several months. 
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Offline minismom

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Re: What exactly is the definition of a suppressed immune system?
« Reply #8 on: September 01, 2013, 06:30:16 PM »
This is actually an interesting topic. I honestly never gave it much thought until I read this post. Just today I wrote, on a medical form prior to her MRI, that Mim is "immune compromised".  However, according to the definitions discussed here and her recent numbers, she isn't.  I assumed that HIV always equaled a compromised immune system. But now I'm reading that it doesn't.

Huh!  After 13 years of living with HIV, I'm still learning something new.

Mum

Another thought: I hope I'm not the only one who does this, but I usually write "immune compromised" so I don't have to write HIV+.  If her HIV is an issue or thought to be related to the issue to be discussed, then of course I include that she's HIV+.  However, on tests like her DEXA, MRI, EKG, EEG, etc., I figured "immune compromised" would suffice.
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Offline Newguy

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Re: What exactly is the definition of a suppressed immune system?
« Reply #9 on: September 01, 2013, 09:46:13 PM »
Hi everyone

This question drives me nits regading "compromised immune system". Last year people close to me took time off work because of flu and sickness, multiple cold sores on peoples lips and the guy with the "compromised immune system" had none of this. It seems everyone around me was sick except me. So that is why I asked. I am not satisfied with the medical terminology used in this example as it can sometimes lag current realities.

Best

Offline JungleJungle

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Re: What exactly is the definition of a suppressed immune system?
« Reply #10 on: September 02, 2013, 03:04:45 AM »
Maybe (i am just guessing) you are on ART and it gives you extra protection against viral infections (flu, herpes and all that stuffs are just viruses)... The meanest problem with immuno deficiency are OI like tubercolosis and pneumonia that are caused by bacteria and mycotic infections
Just my point of view...
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Offline oksikoko

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Re: What exactly is the definition of a suppressed immune system?
« Reply #11 on: September 02, 2013, 11:09:34 PM »
Maybe (i am just guessing) you are on ART and it gives you extra protection against viral infections (flu, herpes and all that stuffs are just viruses)... The meanest problem with immuno deficiency are OI like tubercolosis and pneumonia that are caused by bacteria and mycotic infections
Just my point of view...

Yeah, but I don't think influenza or herpes virus use reverse transcriptase, which is what, in the case of Atripla for example, is what's inhibited by ART. They also don't use integrase as far as I'm aware. So, no dice there.

Maybe we don't get sick as often because we see doctors regularly whereas most people don't, and we all get our flu shots. ;)
Code: [Select]
2013-10-03:                ☣ VL (=) undetectable ☣ CD4 (+) 1105
2013-05-23:                ☣ VL (=) undetectable ☣ CD4 (-) 945
2013-02-25:                ☣ VL (-) undetectable ☣ CD4 (+) 1123
2012-12-16: Enter Stribild
2012-11-20: HIV+           ☣ VL (→) 132,683      ☣ CD4 (→) 920
2012-04-01: HIV-
Dates in this signature file conform to ISO 8601. ;-)

Offline jkinatl2

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Re: What exactly is the definition of a suppressed immune system?
« Reply #12 on: September 03, 2013, 12:26:07 AM »
I rather think those of us on treatment tend to monitor our health better than the average person, and are less likely to get routine colds. Though for some of us, whose CD4s have been ravaged and might never fully recover, GETTING one of those nasty bugs is a much bigger deal. I know I have become a lot more paranoid, especially in public and especially during flu season.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline Newguy

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Re: What exactly is the definition of a suppressed immune system?
« Reply #13 on: September 03, 2013, 05:54:40 PM »
Yeah, but I don't think influenza or herpes virus use reverse transcriptase, which is what, in the case of Atripla for example, is what's inhibited by ART. They also don't use integrase as far as I'm aware. So, no dice there.

Maybe we don't get sick as often because we see doctors regularly whereas most people don't, and we all get our flu shots. ;)

You are correct about reverse transcriptase ( a super cool enzyme by the way), however I think I read somewhere that integrase shares a lot of 3-D structure/homology with terminase found in many of the Herpes family viruses?

Offline oksikoko

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Re: What exactly is the definition of a suppressed immune system?
« Reply #14 on: September 03, 2013, 06:33:50 PM »
You are correct about reverse transcriptase ( a super cool enzyme by the way), however I think I read somewhere that integrase shares a lot of 3-D structure/homology with terminase found in many of the Herpes family viruses?

That's amazing because I mostly just make shit up.

Tell us more about what makes reverse transcriptase super cool. I was taking an online virology course, but I dropped it because I had things to do. As a result, I know nearly nothing about reverse transcriptase.
Code: [Select]
2013-10-03:                ☣ VL (=) undetectable ☣ CD4 (+) 1105
2013-05-23:                ☣ VL (=) undetectable ☣ CD4 (-) 945
2013-02-25:                ☣ VL (-) undetectable ☣ CD4 (+) 1123
2012-12-16: Enter Stribild
2012-11-20: HIV+           ☣ VL (→) 132,683      ☣ CD4 (→) 920
2012-04-01: HIV-
Dates in this signature file conform to ISO 8601. ;-)

 


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