How do we measure effectiveness of Meds?

[Maestro]

With my uncles recent numbers (undetectable, cd4=136 and 12%) it brings a question to mind.  The meds appear to be effective because his VL is so low.  However, his low CD4 and % make me think that no "repair" is going on.  I know there are still some mysteries here, but anyone have any insight?

It would be encouraging to see a rise of his CD4 with the undetectable VL, but after 7 years on meds and no rise above 200, I don't see it ever getting that high.

Thanks
M

[Ann]

From what I understand, the viral load count is THE measure of the effectiveness of the drugs, while the CD4 count is a measure of how well the immune system is doing. The meds don't directly "repair" the immune system - the body does that when given the chance.

The nukes and NNRTIs work by stopping one of the ways that hiv reproduces inside CD4 cells.

The PIs work by stopping any new hiv from leaving the CD4 cell.

Entry inhibitors stop hiv from getting into the cell in the first place - which means the virus cannot replicate.

These three methods only reduce the virus. The drugs do nothing "positive" for the body, other than giving it less hiv to deal with. It is then up to the body to produce more CD4s, something influenced by many factors.

If I remember correctly, your uncle is in his sixties? As we age, the number of CD4 cells decline naturally whether you are hiv positive or not. It could be nothing more than your uncle's age that's slowing his CD4 recovery. As long as the viral load remains undetectable and the CD4 improves - albeit slowly - he should be doing ok.

Ann
 

[Maestro]

Good info Anne.  He is in his 50's.  The thing is, there is no CD4 improvement.  Just a constant level below 200...In this case 130.  And a very low %.  Some of the other older (not old...just older  ) people on here don't seem to have low #'s and percentages related to age.

Anyhow, thanks for the great info.

M

[ACinKC]

If i continue to wake up in the morning I think they are doing their job!!!!

[Miss Philicia]

Look at this way:  sure, we'd like all the numbers to be improving but if you HAVE to choose between VL or CD4's improving you should select the VL.

[Maestro]

Look at this way:  sure, we'd like all the numbers to be improving but if you HAVE to choose between VL or CD4's improving you should select the VL.

Thanks Philly.  But I guess it is just human nature for me to worry.  I mean I read almost all the new posts here, and the people who have been infected for as long as he has all seem to have marginally higher cd4's than him.  However, I think the VL undetectable is encouraging.

M

[Maestro]

If i continue to wake up in the morning I think they are doing their job!!!!

AC,

I agree...to a point.  My Uncle wakes up and then proceeds to spend about 95% of the rest of the day sitting in a chair staring at the television and nodding off.  I expected this in the beginning of this ordeal, but 6 months later I thought he would be much better than he is.

M

[HIVworker]

Ann is pretty much bang on the money.

The recovery of T-cells is a personal thing and depends on many factors, a lot of which are unknown. While the meds are designed to lower the viral load, by stopping new infections, the body's attempt to recreate CD4 cells is dependent on other factors. Age being one of them.

One mistake is to say that the meds are not working because the CD4 count isn't rising. That's not the correct way to see if they are working. They are designed to decrease viral load, in a round about way, and if your uncle is undetectable then they are doing their job. If they are not, then they need to be changed. I would expect that if you want to gauge how well the drugs are doing they should slow or stop the decline in CD4 cells, or raise them. However, that isn't always the case as CD4 cells have been seen to decrease even on meds.

Rich

[AtomicA]

How much outside support does your uncle's immune system get? Unfortunately the damage HIV does to your immune system appears to be cumulitive, at least that's what my doctor and all the studies that I've been reading tell me. I don't know the back story with your uncle, but the lower your CD4 count falls before starting HAART the harder it can be for your body to bounce back. I remember reading a paper back when I was diagnosed that suggested the reason a human immune system can sit at equilibrium with HIV for so long is because it starts mass producing CD4's to make up for the cells that are lost. Even though CD4 white blood cells come from the closest thing to stem cells an adult human body has, every single cell in our body has a certain number of divisions that are possible before it stops. How many divisions are possible depends on the type of cell, with skin and immune cells being the most robust, but as we age, we use up our divisions (shrinking telomers, cumilitive genetic damage, possibly some unknown genetic programming). Having HIV is like rapidly aging your immune system much faster than the rest of your body.

One thing that might help your uncle is micronutrient support if he isn't taking it already. If he is deficient in any of the trace elements or pro-biotics that your immune system needs to build and repair itelf he's not going to be able to make the cells he needs. Lots of people on here don't like it, but I take K-pax, though there are lots of other ways of supplementing you diet. depending on what his diet is like, he might need to look into getting some other types of support - especially if he also has diarrhea which can prevent you from absorbing things from food that your immune system needs.

hope he gets better!

[aztecan]

Hey M,
Atomic hit it on the mark. I know several people right now whose viral load is undetectable but their CD4s are tanked and haven't shown much improvement over quite a period of time.

That is why I usually argue for aggressive treatment earlier rather than waiting until someone is already severely immunocompromised and then hoping to regain what was lost.

Of course, that is a moot point with your uncle. About the only thing that can be done is to make sure nutrition, etc., are good to help assist recovery and take each day as it comes.

Please keep us updated on how things are going for your uncle - and for you. I think he is a pretty lucky guy to have someone care about him the way you do.

HUGS,

Mark