Stubborn CD4s

[Turkmenbashi]

I was diagnosed with PCP in November 2006. At the time my CD4 count was 20, viral load off the charts. My VL went to undetectable a few months after starting HAART. By early 07, my CD4s were at 180, however, since then, they have not risen above 210. They seem to fluctuate in the 160-200 range. As they are not above 200 on a sustained basis, I've been on PCP prophylaxis (Septra) the whole time.

I'm somewhat frustrated at the lack of upward movement in my CD4s and am wondering if there is anybody with a similar experience of a low-plateau count. Is the reason for this known? (My ID says not conclusively and tends to explain my response solely in clinical terms, i.e., "we sometimes see this in people whose counts were very low to begin with...")

I'm wondering if I should expect to ever get a sustained reading above 200 and if I'm ever going to be able to stop the Septra...

[BM]

I've had a similar experience. Starting from a low of CD4 78, after starting meds I had a surge in CD4 (including a probably false count of 400-odd). I've since stalled in the 200 to 240 range. Others have experienced the same. I'm told it can take several years to see significant increases in CD4 when you've been as low as we have. It is frustrating but it's just a big waiting game, it seems.

PS If you're experiencing problems with the Septra, ask your doctor about transferring to Dapsone. It's slightly more expensive but just as good for PCP prophylaxis and has a lower side-effect profile compared to Septra.

[newt]

The later you start the lower the plateau, but wait and see, its amazing (and unxeplained) what often happens several years in - matt

[Tempeboy]

Hey Turk,

Some theorise that some HIV drugs or groups of drugs are associated with higher CD4 counts.  A naturopath that specialises in HIV uses Bovine Colostrum and NAC with good results.  Quitting cigarettes if you smoke can also help.

How is your lung function?

[edfu]

I started HAART with a CD4 of 29 and a VL of 16,000.  My VL became undetectable after only two months, but for three years my CD4 never rose above the low 200s.  It then finally reached the low 500s after I dropped AZT from my regimen and switched from Trizivir to Epzicom.  I decided to continue my PCP prophylaxis, Bactrim, for another year, to be on the safe side.  Newt is correct about starting with a low baseline.  In addition, I was in my 60s, and age is another causative factor for low CD4's with a good VL response. 

[webontheweb]

I too went through no increase in CD4 counts,  I WAS ALLERGIC TO THE BATCRIM THEY GAVE ME.  Have them try another antibacterial right away.  I went off the bactrim andmy cd4 went up 45 points in one month.
Many many people are allergic to bactrim type drugs.  Dapsone is a substitute, but watch for symptons there, too.  Not to worry you, just be aware of side effects.

Good luck, the numbers you got after just one month are fantastic!!!  Keep it up, you are on your way to health!

Cheers

[YaKaMein]

Hey Turk,
I feel your pain about CD4 envy. I now measure my quality of health [being well and feeling well] not quantity of health [T Cells and %]. Have seen plenty of studies that indicate the rebound in CD4's is slooow when they're looow ... but will rebound with effective HAART.

Patience, adherence and living may be all that's left. Clinical trials seeking increasing CD4's have mixed results and so far little sustained response. I believe we'll see higher plateau levels over time.

If you're on Septra [Bactrim DS] daily, try discussing with your doctor reducing it to 3 times a week, like MWF schedule. It's been proved to be an effective OI prophylaxis. When your numbers are sustained well above 200 [have faith they will] or your % is 14%+ for a while, we'll all celebrate with you.