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Author Topic: Are we 'immunocompromised'?  (Read 440 times)

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Offline Deleterious

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Are we 'immunocompromised'?
« on: November 24, 2016, 01:02:33 AM »
I went in to get the first dose of my HEP-B vaccine this afternoon, and instead of one jab I got two. When I sort of raised my eyebrows at the doctor she explained that clinical guidelines prescribe double doses for immunocompromised individuals, such as my wonderful HIV-ridden self.

And it got me thinking - I'm on meds and my CD4 is 650 and climbing. Am I actually immunocompromised? Are any of the guys with normal CD4 counts and low viral titre immunocompromised?

It's proven a bit tricky to research off my own bat, so I'm after some thoughts from the more medically qualified/savvy.

I guess the main questions are...

1. Assuming healthy CD4 count and low VL, are there any conditions/diseases/infections someone with HIV is more likely to get, or more difficult to treat?

2. Does categorising HIV+ people as 'immunocompromised' date from when treatments were nonexistent or less effective? And is it still a valid classification?

3. Aside from the Shanghai-ing of T-cells, what other deleterious effects does HIV have on the immune system?

Cheers in advance for any light that may be shed, whether it stem from personal experience or a forty year career in immunology.

:)
May 2014. Suspected seroconversion.
June 2016. Diagnosed. VL: 970 CD4: 460
September 2016. Initiated Triumeq.
November 2016. VL: U/D CD4: 650

Online JimDublin

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Re: Are we 'immunocompromised'?
« Reply #1 on: November 24, 2016, 02:55:25 AM »
In short Yes, but don't get hung up on terminology or getting a double dose.
Its the same why we get the flu vaccine recommended because we are or belong to a group of people that are ‘immunocompromised"

Your still are part of a group that has an increased risk of infection, OI's and certain cancers that can happen at any level of CD4's and possible complicate treatment.  What you can do is decrease the risks, biggest way is being adherent to the treatment and suppressing the virus as best as possible and cutting out risk factors, also taking preventative measures such as vaccinations against illness.


The term ‘immunocompromised host’ embraces a group of overlapping conditions in which the ability to respond normally to an infective challenge is in some way impaired.

This includes patients with underlying conditions such as protein–calorie malnutrition and diabetes, as well as organ transplant recipients, those with haematological malignancies and others receiving therapeutic immunosuppression, and patients with HIV infection. Many patients have multiple risk factors that increase the risk of opportunistic infection.


Now for vaccinations hep-b I am not going to say much but there is a CDC vaccination information inducing dosing etc here if you are wondering. http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm

One of the FAQ included the question and answer (it goes into more detail on the site)

Can hepatitis B vaccine be given to immunocompromised persons, such as persons on hemodialysis or persons with HIV infection?
Yes, although a larger vaccine dose is required to induce protective antibody in hemodialysis patients. Larger doses or additional doses might also be necessary for other immunocompromised persons.


Jim

http://oxfordmedicine.com/view/10.1093/med/9780199204854.001.1/med-9780199204854-chapter-070204
« Last Edit: November 24, 2016, 03:10:08 AM by JimDublin »
HIV 101 - Index & everything you need to know
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline Deleterious

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Re: Are we 'immunocompromised'?
« Reply #2 on: November 24, 2016, 05:01:16 AM »
Interesting stuff. Looking through the CDC handbook on hepatitis control and prevention (or whatever the full title was) it seems all the referenced studies pertaining to immunisation/risk factors for infection are pretty old. The most recent referenced study was 1995 and the oldest 1988. Which brings me back to the thought that maybe the 'immunocompromised' label isn't as pertinent as it once may have been.

Obviously this could just be a bad example to be looking at, it's quite plausible that there's plenty of modern research that does indicate a less-than-ideal immune response to certain things.

I don't have a qualm about the term or anything, by the by. It just struck me that maybe this is another regulatory/medical area that hasn't been updated or reinvestigated. It makes sense to immunise for whatever you can, considering a lot of HIV+ people automatically fall into the high-risk category. Even before I was diagnosed I was constantly having to fend off offers of potions and injections when I went for STI checks.

Although something I hadn't heard about before 'B-cells' may have a bit to do with this. From what I gather, B-cells are a sort of memory cell, and lurk in bone marrow. They remember past infections and can generate an immune response to a virus or pathogen your body hasn't seen in decades. Apparently HIV is capable of zombifying these cells, meaning your immune system is less capable of responding to repeat infections.

I guess if every time you catch something your immune system is starting from scratch, that could definitely be a cause for concern. Can't find much info on whether HAART helps B cells recover, although there's a few articles that mention there's been cure research involving modified B cells.

Hmm. I find all this stuff quite fascinating. Definitely a step in the right direction from finding it depressing :)
May 2014. Suspected seroconversion.
June 2016. Diagnosed. VL: 970 CD4: 460
September 2016. Initiated Triumeq.
November 2016. VL: U/D CD4: 650

Online JimDublin

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Re: Are we 'immunocompromised'?
« Reply #3 on: November 24, 2016, 07:15:43 AM »
Interesting stuff. Looking through the CDC handbook on hepatitis control and prevention (or whatever the full title was) it seems all the referenced studies pertaining to immunisation/risk factors for infection are pretty old. The most recent referenced study was 1995 and the oldest 1988. Which brings me back to the thought that maybe the 'immunocompromised' label isn't as pertinent as it once may have been.

Obviously this could just be a bad example to be looking at, it's quite plausible that there's plenty of modern research that does indicate a less-than-ideal immune response to certain things.

Yeah, The heb-b I mean I just pulled up the first document on heb-b for the reason/logic of why the clinic may choose to double doze. Presuming they take direction from the CDC.

Which brings me back to the thought that maybe the 'immunocompromised' label isn't as pertinent as it once may have been.

Well I think that is a wider item its not just for vaccinations of course. So Yes we are because we belong to a group that statistically is more prone to illness than HIV negative counterparts. Its also its a case of funding. Governments also allocate services and funds based on this stuff.  Take my region of the woods I get my vaccinations for free as I am a group of people who are 'immunocompromised' without that label I would not get treatment or risk loosing that free service.

In short however ART has reduced rates of illness (and death) without any doubt  but whatever the medical reason or not,  statistical we are still a group that is higher risks for "OI" and Illness so we are 'immunocompromised', from another view we require daily treatment and without treatment and care, HIV could run its course we can not fight HIV without medication.  So with medication we belong to a group that statistically is at higher risk risk group and without treatment it certainly are so  'immunocompromised'.

I think I would have a different point of view if we had equal risks as the HIV negative population but we from all the published literature don't, below as example.


Despite reductions in hospitalization rates associated with widespread use of ART, people with HIV are still hospitalized at high rates, and substantial gender and racial/ethnic disparities persist. Previous work has shown that women and those in racial/ethnic minority groups are less likely to be engaged and retained in HIV care.9,11,14,15 This finding may explain, at least in part, disparities in hospitalization rates. Efforts to systematically remove barriers to care and to find, engage, and retain all people living with HIV in care are urgently needed to realize the full benefits of ART for all groups.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904898/
« Last Edit: November 24, 2016, 07:30:11 AM by JimDublin »
HIV 101 - Index & everything you need to know
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline mecch

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Re: Are we 'immunocompromised'?
« Reply #4 on: November 24, 2016, 04:37:30 PM »
Yes we are immunocompromised.  IMO

On the other hand, IMO I am not sick.  Even my best friend pulls that on me sometimes and its annoying.  Like if I have a stressful period at work, and he says things like - "stress certainly isn't very good for someone who's ill like you, you have to make it clear you have chronic illness" and I have to correct him. It's annoying.

Deleterious - I'm all for learning a fair amount about HIV and living with HIV but personally I decided to see expert doctors and let them be the up to date experts and I just follow their care and get on with my life and doing the things I am expert in.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline harleymc

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Re: Are we 'immunocompromised'?
« Reply #5 on: November 24, 2016, 05:36:03 PM »
Back in the day when my cd4s were a lot higher I had two courses of 3 shots (total 6 shots over about a year and a half) for hep b and didn't gain any effective immunity.

So if your doctor is recommending double shots, I'd say go with their expert advice.

Offline CaveyUK

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Re: Are we 'immunocompromised'?
« Reply #6 on: November 24, 2016, 05:54:59 PM »
Yes, technically immunocompromised, but as Jim said - so are people with Diabetes.

Being on effective treatment should mean someone with HIV can live a normal lifespan, whatever that may be. But there are certain things where the risk of getting it is slightly higher than in the general population...specifically some cancers (thankfully, largely more treatable ones). We are also likely to see certain conditions relating to ageing- if we would be susceptible to them anyway - slightly sooner (cardiovascular issues, dementia etc).

All of these are increased risks, but still small increases so nothing to worry unduly about. As long as you don't have a low CD4 and are adherent to meds, you shouldn't see anything AIDS defining in your lifetime.

On the plus side - We shouldn't get any general illnesses any more than someone HIV negative (bugs going round etc) as much of that is handled by a different part of the immune system and if someone living with HIV makes positive lifestyle changes they may well live longer and be far healthier than if they were negative. We also have access to regular monitoring which will hopefully pick anything nasty up sooner which the average HIV- person may not. Swings and roundabouts.

The problem for someone with controlled HIV isn't actually HIV itself, but is the inflammatory blood markers which are slightly raised due to the latent virus hiding away in 'reservoirs' within the body and which are not destroyed by ART. It is this 'inflammation' which contribute to the ageing issues and quite frankly is the one thing I would hope we can figure out a way to combat, even in lieu of a 'cure'.

Quite frankly, before I had HIV I was pretty immunocompromised due to my lifestyle...little sleep, partying, drinking, eating crap. At least now I can get all the free shit (flu jabs, vaccines etc) available to help keep me healthy ;)
« Last Edit: November 24, 2016, 05:58:01 PM by CaveyUK »
Diagnosed 29th Dec, after Home test 27th Dec 2015
29th Dec 2015 - CD4 160, VL 70,363, CD4% 16
Started Septrin 31st Dec & Tivicay/Truvada 12th Jan 2016
9th February 2016 - CD4 245, VL 96, CD4% 19
8th March 2016 - VL 61 (no CD4 taken)
5th April 2016 - CD4 354, VL  - UD (<40), CD4% 22
5th July 2016 - VL - UD (<40) (no CD4 taken)
13th September 2016 - CD4 432, VL - UD (<40), CD4% 28

 


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