two steps forward, one step back

[elf]

Hi people
I just got back from the I.D. clinic,
here are my new LAB results:

09/05/08   CD4 Count: 353 cells/mm3   
10/05/08   CD4 Count: 692 cells/mm3   
12/05/08   CD4 Count: 937 cells/mm3   
03/05/09   CD4 Count: 1189 cells/mm3   
07/03/09   CD4 Count: 900 cells/mm3

T-CD4 cells are  down to 900 
(I don't know why, maybe because of stress or due to
a HepatitisB vaccine taken 2 weeks before)

CD4% is still a slow riser...from 24.7 % to 25.4 % in 4 months' time...
I guess it will take 4 years to get it to normal values (>35%).

On the other hand, my lipids are good now, even on Kaletra,
MegaTwinEpa Fish Oil (4 ''servings'' a day), 0.5kg of sardines a day,
lots of walnuts, linseed/flax, apples and an occasional oatmeal porridge are doing the trick:

09/05/08   Total Cholesterol: 193 mg/dL   
10/05/08   Total Cholesterol: 231 mg/dL   
12/05/08   Total Cholesterol: 251 mg/dL   
03/05/09   Total Cholesterol: 289.5 mg/dL; omega3 diet started   
07/03/09   Total Cholesterol: 235 mg/dL

09/05/08   Triglycerides: 224.28 mg/dL   
10/05/08   Triglycerides: 429.87 mg/dL   
12/05/08   Triglycerides: 318.62 mg/dL   
03/05/09   Triglycerides: 352.44 mg/dL; omega3 diet started
07/03/09   Triglycerides: 168 mg/dL


Should I be worried about the CD4 decline? Does CD4 # have fluctuations even in a healthy person?
I've been studying a lot for my university exams, studying all night long, with some stress...
Also, there was that stress about unknown people threatening me on the internet/facebook saying: you're doomed, I'm gonna tell everyone you have AIDS...
(These threats have been traced to a former best friend of mine...she has schyzophrenia, I should have never told her about me in the 1st place, she got all paranoid about being close to me and stuff, and she told her friends I don't even know about me ...I guess you can never trust people, not even your best friends...)

Or could it be because I've been taking my pills less punctually (I used to take them
at 8:00 am and 8:00 pm and now I'm giving it a 30 minutes interval [8:00-8;30])...
I've never missed a single dose of meds so far...

Or it could be a reduced selenium intake? I used to take 450 micrograms per day
but I'm taking only 300 micrograms now (fear of selenosis)... 

...

That would be all, thanks for reading.
and hugs and kisses to everyone,
from the hot and steamy Mediterranean region.


PS
I'm going to the Adriatric coast next week, with a short trip to Italy...Will anyone be around? 

[BT65]

Elf, CD4 cells do fluctuate.  If you'd have had the labs taken the next day, you probably would have gotten a different number also.  Many things can cause the fluctuations.  The CD4's are still a very good number (900).  Taking your pills 30 minutes later isn't going to affect them, though.  It could be stress from the studying for the exams.  900 is a very good number, and I wouldn't worry a bit.

[Inchlingblue]

Or it could be a reduced selenium intake? I used to take 450 micrograms per day
but I'm taking only 300 micrograms now (fear of selenosis)... 
 

If you are already getting selenium in your diet, which it sounds like you are, you probably should not take more than 200 mcg./day.

Your CD4s are great, it's normal to have fluctuations.

[jay195]

Hi Elf , your numbers look good so I wouldn't worry . Sorry to hear your " friend " is giving you grief, I haven't told anyone about my status  yet ( coz I trust no one ) . Actually if I had cancer I still wouldn't tell anyone but that's the way I am.  The only people who know the state of my health  are the guy who gave it to me and the medical staff at the hospital, and of course the people I have met on this wonderful website.       
                                Jay and kiss.
                                                                       

[elf]

I got my new results today and I'm sad. My numbers have been going down:

09/05/08   CD4 Count: 353 cells/mm3   
10/05/08   CD4 Count: 692 cells/mm3   
12/05/08   CD4 Count: 937 cells/mm3   
03/05/09   CD4 Count: 1189 cells/mm3   [24.7 %]
07/03/09   CD4 Count: 900 cells/mm3    [25.4 %]
11/27/09   CD4 Count: 721 cells /mm3   [25%]

  The change is almost symmetrical and my new expected CD4 count [in April] will be around 400.

[Miss Philicia]

I guess I can make the assumption that your VL is suppressed and you're on treatment, as you don't mention either thing here and are fixated on your cd4 count.  Just for some context, my cd4s bopped around from 702 to 1400 for a good year with all sorts of numbers in between, and I was on a clinical trial at the time so I could see the fluctuation really well on a monthly basis, something the rest of you usually do not see.  Just because they went down this time does not indicate a trend, and frankly I know you know this after being on aidsmeds for a while.

I'll assume that the 353 number was before starting meds, or soon thereafter -- if you take the rest of the numbers and get an average then you see that you don't have a lot of room to complain about anything.  You have no feasible way to know what to expect from your April numbers so why make that comment?

[elf]

Thanks, Miss Philicia,
yes I am undetectable (I've been since November 2008, two months after starting therapy).
I expected a gradual and slow increase of CD4 and not ups and downs.  

I hope my new numbers will be somewhat better (I started taking Epzicom/Kivexa 10 days ago instead of ba(ttere)d Combivir, along with Kaletra).

[Miss Philicia]

elf, you really, really have super great numbers.  They'll go up and down so don't stress about it all.  When your cd4s are fluctuating then that's when it's good to look the % number, and yours are completely consistent.

Look at it this way, even with ~700 cd4 you can catch some nasty bronchitis and get rid of it as easily as a non-HIV infected person.  Personally I think once you go above 700 as a practical matter it doesn't do all that much for you.  You'd get rid of bronchitis in the same amount of days with your 1189 number.  They're just kind of bonus points on a piece of paper.

[megasept]

Should I be worried about the CD4 decline? Does CD4 # have fluctuations even in a healthy person?...


I've been studying a lot for my university exams, studying all night long, with some stress...
Also, there was that stress...
Or could it be because I've been taking my pills less punctually (I used to take them
at 8:00 am and 8:00 pm and now I'm giving it a 30 minutes interval [8:00-8;30])...
I've never missed a single dose of meds so far...

Or it could be a reduced selenium intake? I used to take 450 micrograms per day
but I'm taking only 300 micrograms now (fear of selenosis)...  

...
I'm going to the Adriatric coast next week, with a short trip to Italy...Will anyone be around?  

Elf:

Hey! My general message is don't worry about what you report. Here are my reasons based just on my own blood work history. BTW: None of what I write below applies to newly POZ CD4 fluctuations.

The higher your CD4s the more numeric fluctuation you may see. Without meds (pre-1998) my CD4 range was 670-900; and with meds it shot up to 1100-1400 for a good while. These highest numbers may have been of no benefit (MD said she'd like to grab a few for her low T-Cell patients). Even pneumonia registered as a mere "blip" down.

I don't know for sure whether everyone healthy has big CD4 fluctuations, but certainly many relatively well-off POZ do have these fluctuations.

I believe stress's affect on our immunity is entirely overrated. In my case stress, and sadness/depression, has had an INVERSE correlation (probably just unrelated) on my CD4 count. I think the actual connection between say, depression and CD4 is this: miserable people often DO less of what they should do (eat well, stay active physically, take meds like compliant patients) or WORSE (drug/alcohol/food/other self abuse). When I was blue (3 years) I forced myself to do absolutely everything good (work, exercise, eat well) as during happier days. So my behavior did not reflect my moods.

Don't any of us "stress" for having "stress". We have enough on our plate without worrying about "worrying too much."

I have slept in lately (with not alarm) so i've taking meds up to an hour off schedule. I am trying to do better. I DOUBT 1/2 hour off-interval will upset your dosing any (Ask your MD next visit).

As for Selenium, there is lots here and elsewhere to read. Seems like we need some, but not too much. This is true for various minerals/supplements.

The Adriatic...I wish  

Don't worry. Good Luck with your Studies!

-Steven (aka    megasept)