Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

CD4% info and Trend after treatment

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newt:
Hello

All the big studies use CD4 count as the marker to measure. Hence precious little really good info about CD4% and starting treatment. US, European and UK guideline comment that a low CD4% may be a reason to consider treatment. A CD4% of 12-15 usually equates to a count of 200 or less. One of 29+ to a count of 500+ but there is more variation at the top end.

So, a CD4% of 16....me, personally I'd want to see what the next test says. A CD4% is the proportion of all lymphocytes that have the CD4 marker. If, say, your lymphocytes were greater because you had a cold or some other reason, the CD4% would be lower.

But also, if on the next test my CD4% was 16 or under I'd be thinking about starting meds.

- matt

eric48:
The question about 'trend' should be considered carefully...

Your CD4% does not exhibit a trend as per definition given here:
http://en.wikipedia.org/wiki/Trend_estimation

In particular, it may be useful to determine if measurements exhibit an increasing or decreasing trend which is statistically distinguished from random behaviour.

I guess you are considering that CD4% may have a time dependent behaviour. It does in a way, of course.

Yet, if that would be true, then the CD4% dynamics would be governed by an ordinary differential equation in the form of:
dCD4%/dt = f(t) + ...

In fact, the few models I have seen would rather be in the form of:
 dCD4%/dt = f(CD4%) + g(CD8%) + ...

Models in the form of:
dCD4/dt = f(t)+ ... do exist (unfortunatly, they do...this is called disease progression...), but usually not in the form of CD4%

On the other hand your VL is showing potential for a trend: divides by 2 every 3 months

If the next blood draw, in 3 months I suppose, gives you a VL around 15 k (or even below...), then you might have a trump card in your hand: the immune system might be able to lower VL on its own. This is rare but not unseen : you win (*)

On the other hand if VL comes back in the 50k : you don't win

(*) your doc offered Epzicom, therefore you should have the HLA***57 test done:
- if neg: Abacavir = OK  (in one way, good news)
- if + : this allel is a (modest, but widely accepted) predictor for ability to control the infection (thus, even better news) 

I'd cast vote for waiting one more draw

As per your main concern: Trend after treatment: it goes up in a vast majority of patients who start below range, so you should not be over concerned by the non-responder stuff you read here and there.

Hope this helps

Eric

new_2013:
Thanks Eric, unfortunately I am just given the CD% in my results so cannot go into the detail you have references. You comment about strategy is useful and something I will consider.

Matt, thanks for your response also. Yes, it was the comparison of CD4% of 15% equating to a CD count of 200 that was worrying me.

I agreed with my consultant that I would start treatment next month (appointment booked for 12th Dec) but I may wait and get another set of bloods done end of Jan just for my own peace of mind (and gives me the time to research treatment options a bit more and make inner 'peace' with going on meds).

new_2013:
Eric,
   Just seen your recent post after I responded. Thanks for that, makes sense (except for the equations, maybe next year I will understand them.. ;-) )

I am veering towards "one more draw" as you say. If nothing else, it will help me 'connect' better to my body and its own behaviour during this time (if that makes sense).

eric48:
Hi,

You asked for 'trend' ;-)  that was calling for (maths) trouble. No problem, it took me months (if not years) to put that % thing into perspective.

% is very useful in clinical decision; say you are an ER doctor and have a sick patient. you have to react quick. Moreover you have to act on a snapshot of the patient's condition. This is where the % is useful.

It has long be debated which of absolute count, % or ratio (CD4/CD8) is a better 'predictor'. As far as % and ratio, in the low end, they are almost identical mathematical objects. I'll explain this in about a month or so, but, for the time being, just bear with me. 

So it is down to absolute count and whichever of the remaining 2.

Just a few inches, even an inch to that:
http://www.youtube.com/watch?v=xwoh70n0kh8

you can see fishes and dragonflies going business as usual...in a water that is virtually still

What mean here is that as long as you are on the plateau, there is no sense of danger. At 16% you are not accelerating to a fall.

Here are my numbers
18
16
20
---started meds
29
32
30
28
32
35
32
35
30

You will see mine are 16, 18, 20, like yours. Also strangely enough, I had way more even numbers than odd. I started being suspicious that the % measured in a commercial assay is not very precise or at least not as precise as you would expect. (Later, I had to rule out a bias towards even numbers, but, somehow remained uncomfortable about this)

Anyway, at 16 my % went up, so on a plateau, there is NO trend and a reading at 16 is not very different from 18 or 20.

The Lymphocyte compartment has 3 'majors' : Tcells (aka CD3+) with 2 'main' subsets CD4 and CD8 and the rest, Bcells, aka CD3-. This is a rather simplistic view but good enough to explain that , if , for some reason, your CD3- compartment has expended by 1 or 2 %, your CD4 may lose 1 or 2 %, and this has nothing to do with a 'drop', and, more importantly, nothing to do with a change in the relative density CD4 vs CD8

You are in the plateau, not in the falls. not even sufficient evidence that you are going towards the falls, so there is no real reason to rush to meds.

As much as there is no reason for not going on meds.

That the problem with a plateau: there is no trend: you can't decide

The 14% is definitively a benchmark. you hit that one, you go for meds and everything will go fine.

There are many posters in the forums... Very, very few report a non-response, so you should not be worried.

To get used to this one new item on your daily schedule (take yours meds without fault) you can train yourself. Kivexa is orange-yellow and very similar in size as a multivitamin, so buy yourself 2 different multivitamins and train yourself at gobbing these 2 pills without miss EVERY day.

Have you had the HLA **??57 test already ? (sorry can't recall the exact name)

It is a must do before starting Kivexa, it takes 3 weeks and doctor can not retain the results form you as this is information about your own personal genetics (not about the virus genome...), therefore you have legal access to it.

If I were you, I'd insist to get my CD8 data given to me.

Sometimes docs may refrain from giving it because, in as much as your CD4% is under range, the CD8%, conversely, will most likely be out of range as well (overrange)...
This is just mechanical (kind of) and make the patient over worried that he/she has 2 parameters out of range. No, they are paired, so it is not an additional reason to stress out.

as you have an appointment soon, you may ask your doctor if the VL trend (in the right direction) is something that you should want to explore

The chances that your immune system has found the way to contain the infection are slim, but, the immune system is working at it, generating many many various antibodies combinations randomly. The rule of thumb is that it takes about 18 months for that Darwinian Russian roulette to find one, which is fairly good news, and the sad news, is that in 18 months, the virus has plenty of time to generate a new mutant. So the arm race is, in general, not in favor of the patient. But, you might get lucky.

Hope this helps

Eric (not a doctor...)

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