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Author Topic: Low CD4's after 2 years on meds  (Read 1491 times)

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Offline Buckeyerob75

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  • Posts: 25
Low CD4's after 2 years on meds
« on: December 12, 2013, 11:52:20 AM »
Hey gang! Well I've been on meds for almost 2 years and still my CD4 is low. I started off at 129 when I was diagnosed with a VL of 59,000. I began on Atripla and bactrum and my VL went to UD within 3 months but my CD4 took over a year to even get to 200.

I switched to Stribild about a year ago now and VL is still UD but my CD4 went to 356 but most recently my labs show it's back down to 298.

I had cancer about 15 years ago and underwent chemo and radiation for about a year. I'm not sure if that could be the cause of the low CD4. I've discussed it with my ID and she wants to take the 'wait and see' approach. I've had several bouts with skin infections and a few severe cold/flu sick days in the last couple months.

I guess I'm frustrated more than anything and wondering if I should be trying or doing something else/more? Ideas? Thanks  ;)
6/2011- Tested Negative
1/2012- Tested Positive- CD4 180/VL 105,000
4/2012- CD4- 129/VL 29,000
4/2102- Started Atripla
11/2012- CD4- 157/VL 40

Offline drewm

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Re: Low CD4's after 2 years on meds
« Reply #1 on: December 12, 2013, 02:31:06 PM »
Hey Buckeye...

Three years since dx and on Atripla. My CD4 is around 282 (dx was 008). Doc says not to expect anymore significant rebound, that 282 is, essentially "fine" as long as VL remains suppressed to undetectable (which it does). She told me that starting off so low (008) and at my age (51) my body wouldn't be creating new Tcells at a big rate anyway.

Forgot to add that she said baseline CD4 is 800-1200 but can range from 5-800 in otherwise healthy people.
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

Offline klassykitty

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Re: Low CD4's after 2 years on meds
« Reply #2 on: December 12, 2013, 09:12:04 PM »
 Hello Buckeye

I was diagnosed almost three years ago. I am on truvada, isentress, bactrim, zithromax and take a multivitamin.    When I was  diagnosed my cd4 was 33 and at my last doctor visit in October I was up to 185.  Shortly after my diagnosis I had a MAC attack and was also keeping cervical cancer at bay both of which I am over.  My vl has also remained UD except for one blip and a slight increase when I had that MAC thingy.

Like Drews doctor my doctor also says not to hold my breath for a big rebound due to age, I was 46 when I was dx'd, and other female crap girls my age start to go through.  His theory is that as long as I stay UD, and my Cd4 goes up and not down to much then something is working and not to worry to much. He also tells me to expect my CD4 to possibly go down at times especially in the winter time.

 Tips:  I don't stress to much about it, and just try to take care of myself.  Nurse Vampire had the pleasure of giving me a flu shot again this year >:( .

Another thing my doctor told me  in the beginning was to take my meds on a regular basis (I succeed most of the time). 

Michelle 8)

How to handle stress like a dog:
If you can't eat it or play with it.....
then pee on it and walk away

Diagnosed 01-20-2011
01-23  CD4 32    VL 125,400
02-18        76     VL 189
03-14  no cd4 test done   VL-52
04-14   69  VL-UNDECTABLE  YEA!!
05-26   50  whoopsy  
06-27   71        %-7
08-15   64 WTF %-9 
10-16  80         %7  
2012  CD4  %Thing   VL-UD
01-18  87    7
04-18  93    8  
07-16  151  8         
10-18  83    9    VL-70
2013   CD4   %thing       VL-UD
01-28  121     9
04-24  148    11   
07-25  157    11   
10-22  185    13
2014   CD-4  %thing   VL-UD
02-07 201 YEA!!!!!!  12
06-03  205      12

Offline harleymc

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  • Posts: 196
Re: Low CD4's after 2 years on meds
« Reply #3 on: December 12, 2013, 10:25:35 PM »
Low is a relative term.
You're out of the danger zone for opportunistic infections and oportunistic cancers. As long as your viral load's controlled you'll be fine.

For what its worth I've chugged along with less than a hundred cd4s for years and years.

Offline witch

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  • Posts: 59
Re: Low CD4's after 2 years on meds
« Reply #4 on: December 13, 2013, 05:27:31 AM »
CD4 counts vary by about 50 by the time of the day. The count is also proportional to your body weight -  when your body weight increases, you are producing more CD4 cells. I know that from my personal numbers and I've seen it confirmed in papers that CD4 'correlates positively with body weight' while CD4% does not.

The real indicator of your immune system health/balance is CD4% which doesn't vary much with time of day or body weight. It indeed increases very slowly for people that started at a small value.

There are studies (below) that low dose Naltrexone can be used safely as addition to the HIV drugs and that it increases CD4 and CD4% faster than just HIV drugs alone. Discussing that with your doctor will be useless unless you print the studies for him/her. Then you have some chance a non-brainwashed doctor to prescribe it.

Studies:
LDN combined with standard ART increases CD4 and CD4% faster compared to just ART:
Impact of low dose naltrexone (LDN) on antiretroviral therapy (ART) treated HIV+ adults in Mali: A single blind randomized clinical trial. Journal of AIDS and HIV Research Vol. 3(10), pp. 189-198, September 2011
http://academicjournals.org/article/article1379515379_Traore%20et%20al%20(2).pdf
« Last Edit: December 13, 2013, 05:50:38 AM by witch »

Offline Buckeyerob75

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  • Posts: 25
Re: Low CD4's after 2 years on meds
« Reply #5 on: December 13, 2013, 07:12:06 PM »
Thanks for your responses I appreciate you taking the time to share your experiences with me :-)  It helps to know I'm not alone.
6/2011- Tested Negative
1/2012- Tested Positive- CD4 180/VL 105,000
4/2012- CD4- 129/VL 29,000
4/2102- Started Atripla
11/2012- CD4- 157/VL 40

Offline wolfter

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  • Posts: 4,332
Re: Low CD4's after 2 years on meds
« Reply #6 on: December 13, 2013, 08:36:25 PM »
The lower the CD4 when starting meds, the longer it'll take to rebound to whatever your normal is.  Being in single digits, it took me years to hit the 500 mark where it pretty much remains.  Unless you ever had a baseline test before becoming infected, you'll never be sure what your numbers were for comparison.

Wishing you the best
Wolfie
productivity breeds content

Offline leatherman

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  • Posts: 6,047
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Re: Low CD4's after 2 years on meds
« Reply #7 on: December 13, 2013, 10:20:55 PM »
cd4 counts can actually vary by 100 pts in any given day -with lower counts in the morning and higher counts in the early evening.

my story, which sounds like others here, should help you see your situation isn't so unusual. it took me 12 yrs to reach undetectable and over 200 cd4. Matter of fact after 21 yrs of meds this month, I'm still lucky to keep hitting near my "normal" of about 315....

... and yet with only those few, I haven't been back in the hospital or even very sick at all since 16 yrs this March. It's not how many cd4s you have but how well they work.

Sadly though there's not much you can do to raise your cd4 except take HAART and hope your immune system recovers more.
leatherman (aka mIkIE)


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

Offline witch

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  • Posts: 59
Re: Low CD4's after 2 years on meds
« Reply #8 on: December 16, 2013, 01:50:25 PM »
Buckeyerob75,

you should also be aware that HIV drugs are not equal in terms of how much they raise CD4.

I've seen statements in papers that some HIV drugs toxicity suppresses CD4 increase.

For example, in comparison papers, a regiment based on Integrase Inhibitors (Stribild, Tivicay etc) usually raises CD4 faster than other combos probably because Integrase Inhibitors have less effect on metabolism compared to older drugs.

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Offline newt

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Re: Low CD4's after 2 years on meds
« Reply #10 on: December 16, 2013, 03:03:01 PM »
To the OP

Weight and CD4 recovery: being underweight (as defined by standard BMI index) will see you gain less CD4 cells on average, but the study samples are small, including here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122603/

Being normal to ample will show marginal differences in Cd4 gain, they are more or less comparable.

The low dose naltexone idea has credence in the first 9 months of ARV therapy but the absolute gain is small overall, 10s or 20s of cells, and dimishes with more time on ART.

Integrase inhibitors like raltegravir (Isentress) and elvitegravir (in Stribild) seem to do well at allowing CD4 count to rise. The reason integrase inhibitors allow for new CD4 cells is because they encourage growth of new CD4 cells (by some mechanism, there are theories but no definitive position).

Time is a great healer, and, perhaps like me you will see some jumps now and then and levels in between. This happened to me. Took 6 years to go from sub-200 to 600+.

5% of people will have a usual CD4 count of under 380. Normal is just what shows in the whole population.

All the best

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

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Low CD4's after 2 years on meds
« Reply #11 on: December 16, 2013, 04:19:35 PM »
Buckeyerob75,

you should also be aware that HIV drugs are not equal in terms of how much they raise CD4.

I've seen statements in papers that some HIV drugs toxicity suppresses CD4 increase.

For example, in comparison papers, a regiment based on Integrase Inhibitors (Stribild, Tivicay etc) usually raises CD4 faster than other combos probably because Integrase Inhibitors have less effect on metabolism compared to older drugs.

Some links to credible studies to back up your claims would be nice. It's like you're purposely trying to scare newly diagnosed people and I'm starting to question your motives. I'm watching you again.

Ann
Condoms are a girl's best friend

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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 witch

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  • Posts: 59
Re: Low CD4's after 2 years on meds
« Reply #12 on: December 16, 2013, 11:49:29 PM »
I'm trying to scare new people because I stated a fact present in almost any paper that compares integrase inhibitor to another regimen?

Good job moderating but first get rid of the paranoia.

Offline drewm

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  • Mmmmmm Hmmmmmm!
Re: Low CD4's after 2 years on meds
« Reply #13 on: December 18, 2013, 01:21:29 PM »
I'm trying to scare new people because I stated a fact present in almost any paper that compares integrase inhibitor to another regimen?

Good job moderating but first get rid of the paranoia.

Some links to credible studies to back up your claims would be nice.
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

Offline newt

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  • the one and original newt
Re: Low CD4's after 2 years on meds
« Reply #14 on: December 19, 2013, 06:28:31 AM »
Here's some

Early but limited effects of raltegravir intensification on CD4 T cell reconstitution in HIV-infected patients with an immunodiscordant response to antiretroviral therapy
http://www.ncbi.nlm.nih.gov/pubmed/23677919

Conclusion: Raltegravir intensification modestly impacts viral dynamics and induces a rapid but limited gain in CD4 T cell counts in immunodiscordant patients. Residual viral replication does not seem to be the main cause of unsatisfactory CD4 T cell recovery in these patients.

Link is just the abstract, the full paper's worth a read if that's your kind of thing.

Impact of Raltegravir on immune reconstitution and thymopoiesis in HIV-1-infected patients with undetectable viremia
http://www.jiasociety.org/index.php/jias/article/view/17657

A switch study showing significant gains after 6 months on raltegravir - 448 CD4 cells/mm3 9range 288-575) vs. 322 cells at baseline (range 242-594), but whether this is sustained long term, or makes a difference to health and longevity is unaswered. The interesting thing here is the effect of raltegravir on the thymus, a key part of the immune system

These findings not necessarily generalisable to other integrase inhibitors

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

Offline eric48

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Re: Low CD4's after 2 years on meds
« Reply #15 on: December 19, 2013, 02:53:23 PM »
Hi,

to give you a perspective on the time it needs... Half life of a (healthy) CD4 is 6 months, so 2 years is no more than 4 cycles , so to speak

I had an almost immediate gain of 200 (from 500 to 700): it stayed this way 3 years
Small fluctuations, but the average gained 1 in 3 years!

Then, around y. 3 , a sudden rise of 700 in 2 months. That increase is sustained and should leave me in the 1000s for a while (it has for the last 6 months)

Time and age matter.

People > 50 have a smaller (to none) thymus, so maturation through the thymus is less for them than homeostasis (self replication to maintain population)

Time , time, time

Hope this helps

Eric

Offline drewm

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  • Mmmmmm Hmmmmmm!
Re: Low CD4's after 2 years on meds
« Reply #16 on: December 19, 2013, 03:55:48 PM »
Hi,

to give you a perspective on the time it needs... Half life of a (healthy) CD4 is 6 months, so 2 years is no more than 4 cycles , so to speak

I had an almost immediate gain of 200 (from 500 to 700): it stayed this way 3 years
Small fluctuations, but the average gained 1 in 3 years!

Then, around y. 3 , a sudden rise of 700 in 2 months. That increase is sustained and should leave me in the 1000s for a while (it has for the last 6 months)


Time and age matter.

People > 50 have a smaller (to none) thymus, so maturation through the thymus is less for them than homeostasis (self replication to maintain population)

Time , time, time

Hope this helps

Eric


Eric this makes a tremendous amount of sense and is easy to understand! Thanks!
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

 


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