Can someone explain please....

[dingowarrior]

When i was first diagnosed this past april of 06,my cd4 was at 120 & VL at 52,000.
my doctor said i've had the virus at least 4 years.
my question is,
Why do some people with a higher cd4 than i had, have VL in the hundres of thousands,while mine was just at 52,000.With a rather low cd4 at 120.

PS.
im currently Undetectable and cd4 at 229.

[Boo Radley]

I'm sure Tim Horn or newt or others can give a more scientific explanation but the bottom line is HIV is a crapshoot in every person it infects.  Besides the virulence of the HIV strain people are genetically predisposed, probably on many different but not fully understood levels, to react differently to infection.  There is no "typical" HIV infection for anyone, just averages and cumulative statistics about a large group of those infected.   While trying to live as healthily as one can (e.g., nutrition, exercise, stress reduction, mental/emotional health, nutritional supplements, etc.) probably improve one's overall fight against the battle I've also seen too many very healthy people wither and die to say healthy living is a guarantee (and seen quite a few chain-smoking, hard-partying guys live long past what I'd have expected).   My viral load never went above 30,000 but eventually my CD4 declined to 169 before I belatedly hopped onto the HAART wagon. 

Researchers are only recently (for the most part) acknowledging the inefficiency of current HAART to change HIV levels in the GI tract, lymphatic system, nervous system, and who knows what else?  I'm no doctor (but I play a nurse's aide on TV) but I guess while HAART helps reduce/reverse the debilitating effects on the immune system we've still got a lot more to discover about how this little bugger attacks the human body.

Good news about your current stats!  Keep it up!

Boo

[marc11864]

dingowarrior It's not necessarily true that by reviewing your labs, etc.,  that your doctor would be able to tell definitively when you were infected. I myself knew fairly certain when I was infected based on previous HIV tests and for sure when I sero-converted based on my symptoms. Even before I got the official diagnosis, I knew. By the time that I had my first lab tests, which were only six months later, my t-cells had already reached 170 and my VL was in the 80,000s. Numbers change differently in everyone but a number of factors including those offered by Boo and such as substance use and living with high stress after infection can contribute to these variables. In short, as Boo also stated, it can be a crapshoot.

Part of the trouble is that in most cases of HIV infection, the person will never have a clue as to what their t-cells were PRIOR to infection as it is not something that is routinely tested before infection. For all either you or I know at this point, our t-cells might have been somewhat on the low side even before infection.

[Central79]

Hey Dingo

In acute HIV infection viral load tends to be high, and CD4 count falls from whatever is "normal" for that person. The body goes through seroconversion and starts trying to make antibodies to the virus, and virally infected cells, as best it can.

After acute infection, assuming there is no ARV treatment, the body reaches a "set point" with the virus. The bodies immune system has got the virus under a variable degree of control, reflected by a roughly constant viral level. The virus is still knocking out CD4 cells, but at the moment the body can cope and CD4 only declines slowly - the body in a state where it is largely able to replace the billions of CD4 cells being knocked out every day.

This steady state can last for years. Eventually, the virus mutates and escapes the brakes that the immune system is putting on its replication. VL jumps massively and CD4 drops, opening the body up to all sorts of uglies. The person progresses to AIDS and dies. HAART ensures people don't get to this point if they start early enough.

The various VLs, CD4s and time taken inbetween different levels of VL and CD4 vary a lot - both with the individual  ("long-term non progressor", "fast progressor") and the type and strain of the virus, and how it interacts with your immune system.

The people you talk about with high viral loads, and high CD4 are most likely recently infected. They may have started with a high CD4 anyway, and only had a slight drop due to seroconversion. Eventually viral load will come down, (like mine is doing now please God) and reach an equilibirum with the immune system. Your doctor is probably basing your "infected at least 4 years" by assuming you had a CD4 on the lower range of normal for your lab (which is about 400) and a highish rate of CD4 cell decline. Bear in mind CD4 fluctuates by upto 40% normally - moving into lymph nodes and out into the blood where it's measured depending on time of day, how much sleep you've had, whether you're on the period  or whatever. That's why CD4 percentage is important.

But now you're on meds and doing well - congrats.

Matt.

[dingowarrior]

thank you guys for the info.