Lab Results

[Charles.M]

Looking at my recent blood test and on 26 may my CD8 was slightly elevated @ 1266.
After 2 months on treatment they have jumped to 2248, normal range is 180-1170.
Is this something i need to be concerned with? Why are they so high and will they come back in the normal range? I will discuss this with ID doc next visit.

Also have another question; My Id doc just had me tested again for Hep A AB again. I have previously had negative Hep tests for all of them. Why is she rerunning these tests? Can I develop Hep even though I am neg now and not sexually active or an intravenous drug user???

Thanks for any insight on this

[Jim Allen]

Also have another question; My Id doc just had me tested again for Hep A AB again. I have previously had negative Hep tests for all of them. Why is she rerunning these tests? Can I develop Hep even though I am neg now and not sexually active or an intravenous drug user???

Thanks for any insight on this

Keeping this answer short: Hepatitis A can be acquired through contaminated food or water, and Hepatitis B can come from contact with blood or from sex, needles, razors and toothbrushes. It survives well outside the body and is estimated to be 50 to 100 times more infectious than HIV.

More information can be found here:
https://www.hepmag.com/basics/liver-health/can-hepatitis-a-prevented & https://www.hepmag.com/basics/liver-health/hepatitis-b-transmission-risks

Of course, it's standard practice to screen for these and many other things (depending on where you live), and this is mainly out of routine (+patients also lie), as co-infection can be problematic.

Talk to your doctor, but I am guessing they will tell you something very similar to what I mentioned here, that it's routine. Prehaps get vaccinated against Hepatitis B down the line.

My labs also include syphilis screenings. Keep telling them I wish I were at risk; at least I would be having some fun 

[Charles.M]

I asked her about vaccinations a month back and she wants to see my CD4 count higher before getting vaccinations. I specifically want Hepatitis (A & B), Shingles. Lucky for me, I already had Pneumonia vaccine a few years back in prep for a work related trip to UK and Scotland.

Still worried about mt elevated CD8 count @ 2248, my CD4 did jump alot quickly but my CD4/CD8 percentage ratio only went from 4% to 5% because CD8 jumped up alot?

 

[Jim Allen]

I specifically want Hepatitis (A & B), Shingles. Lucky for me, I already had Pneumonia vaccine a few years back in prep for a work related trip to UK and Scotland.

Yeah, there is a whole list of the recommended ones.

https://www.cdc.gov/vaccines/adults/rec-vac/index.html

Vaccines you need
Vaccines are especially critical for people with chronic health conditions such as HIV infection. Vaccine recommendations may differ based on CD4 count. In addition to vaccines recommended for all adults (COVID-19, Flu (influenza), and Tdap or Td), make sure you’re up to date on these vaccines:

Hepatitis A vaccine
Hepatitis B vaccine
Meningococcal conjugate vaccine (MenACWY)
Pneumococcal vaccine
Shingles vaccine (zoster)
If your CD4 count is 200 or greater1
In addition to the vaccines listed above, you may need these vaccines:

Chickenpox vaccine (varicella) – recommended for all adults born in 1980 or later
MMR vaccine (measles, mumps, and rubella) – recommended for all adults born in 1957 or later
You may need other vaccines, too
You may need other vaccines based on your age or other factors, too. Talk with your doctor to find out which vaccines are recommended for you. This may include:

HPV vaccine (human papillomavirus) – recommended for all adults up through 26 years of age, and for some adults aged 27 through 45 years
Footnote

1If CD4 percentages are available, CD4 percentage should be 15% or greater.

[Jim Allen]

Still worried about mt elevated CD8 count @ 2248, my CD4 did jump alot quickly but my CD4/CD8 percentage ratio only went from 4% to 5% because CD8 jumped up alot?

Yeah, so (CD4%) is just the percentage of white blood cells (lymphocytes) that are CD4 cells, and your CD8 is up, so % wise not much change, but saying that your CD4 count has not changed much either, so it's pretty stable. What was it 70 and now 163?


A lot can be said about CD8 as a topic and HIV. I've re-written a reply to you seven times this afternoon... Prehaps some of the other members might be able to explain this better.

I'll try to keep it brief, so firstly, do talk to your healthcare provider.

The increase could be a general infection causing the additional spike for the moment as your immune system starts to recover, don't overthink this. However, CD4 depletion resulting in higher CD8 is the most generic answer as you are living with HIV.

Theoretically, your CD4 counts will slowly increase, CD8 activation will end, and counts should somewhat normalize. However, not much point worrying about this as there is not much you can do about it, and this is only a snapshot moment when you have only recently suppressed the VL & starting with AIDS and are new to treatment.

Give things time and see how it trends out.

Theoretically, your CD4 counts will slowly increase, CD8 activation will end, and counts should somewhat normalize

However, I should add that your CD8 counts or ratio might not return to normal. Looking back at your results, the CD4:CD8 ratio is 0.072, if I am not mistaken (163/2248). So inverted, this happens with HIV, particularly in the acute and AIDS stages. An inverted ratio is sometimes seen in healthy HIV-negative peers as they age. 

Some studies indicate that persistent high elevations in CD8 count in people despite prolonged usage of ART (years) are linked to an increased risk of non–AIDS-related mortality. Still, there is no point stressing about the numbers.

https://www.aidsmap.com/about-hiv/cd4cd8-ratio
https://academic.oup.com/cid/article/76/9/1688/7071939

If you want to do something to help yourself, focus on the things inside your control, not the numbers!

Take your meds daily, don’t smoke, eat a healthy diet, exercise, drink less alcohol, and get other issues you may have treated.   

[Jim Allen]

Forgetting about the numbers for a moment, How are you feeling/doing?

[Charles.M]

Jim thanks for asking, hope all is well withg you. I think I am an anomally I feel fine physically, though I technically have aids or did maybe over 200 now. Amazingly I went from CD4 @ 72 to CD4 @ 163 in two months.

I have not had any OI except minor case of thrush, very minor. I do get joint paint sometimes (inflamation), but that is pretty much clearing.

If it were not for my blood work I would not know I was sick. Been working in the yard and around the house alot and manage to keep going without issue. I am extra careful wearing gloves and mask when around chemicals and things as an added precaution.

So for someone with aids I cannot complain, My ID doc said I should be covered with lesions inside and out. I guess what few CD4 I had were strong buggers!

Anyway the mental mindf#%! goes on and I'm sure it will till I die, it does get better day by day. While not the least bit happy with my situation, I have come to terms with it somewhat, and take each day as it comes.

When I read some folks posts on here I count my blessing and pray for them. Tonny great guy bless his soul has had it very rough.

Anyways its all good so far, and as MY CD4 rise it should get better I hope.

[Jim Allen]

Anyway the mental mindf#%! goes on and I'm sure it will till I die, it does get better day by day.

Glad to hear you are physically feeling okay and the mental aspect is getting somewhat better.

Look, if you are feeling okay, that's all that really matters.

Tonny great guy bless his soul has had it very rough

https://forums.poz.com/index.php?topic=65282.msg

Yeah, rough times.

[Tonny2]

          ojo.            @Charles M., your numbers are going to be crazy, your body is fighting a tough battle, they will get to a normal level when your meds “get rid” of the virus, that n the other hand, it’s better to have your cd8 higer than lower brcause it would indicate a bad illness named DILS, google it, I got it, it was  not fun…Ask your doctor why she/he is repeating tests (hep A and B)…I’m glad your are feeling better and you are on your way to take back control of your life. while the meds take control off the virus… good luck, and please keep us posted.

[leatherman]

two things I could add into this convo.

First, screenings. Of course, I can only speak to the USA; but almost all clinics that treat PLWH end up under the jurisdiction of the Ryan White program either through clinic acceptance of funding or accepting patients receiving RW funding. This acceptance comes with requirements of the Quality Management of RW. In order to keep up with these requirements (collecting data for various measurements and responding to that data to increase the quality of healthcare), most clinics end up taking every patient into account rather than only RW-funded patients.

To lower comorbidities to HIV, screenings of other STIs are done on patients, usually yearly, to head off or to treat the other issues for better health for the patients and less STI in the community. Many of these RW quality measures for syphills, Hepatitis, gonorrhea, etc can be optional. For example, in the Charlotte TGA (transitional grant area - an area specifically monitored due to high HIV prevalence) monitors 5 NC and 1 SC counties. Since NC is #3 for syphilis, this TGA Quality Management program requires yearly syphilis screening and uses the aggregated data to put in place more interventions to prevent syphilis and to make sure syphilis is diagnosed and treated to help reduce the prevalence in the area.

My labs also include syphilis screenings. Keep telling them I wish I were at risk; at least I would be having some fun 

ROFLMAO

our doctor usually takes Larry and I in for our appointments at the same time. You know, I live with him and have seen him naked so after a decade it's not like we have health or sex secrets from each other LOL. It's always a hoot when the syphilis/gonorrhea/chlamydia testing comes up and I get to turn to Larry and ask if someone else has been fucking him lately. The doc blushes, we laugh. We'll do it again in a year. LOL

Second, after that laugh break  , is add to what Tonny talked about. In the early part of treatment, your body is going through a lot fighting back HIV. It takes time for the meds to take care of the HIV, knocking it back to that small amount of residual HIV left in the reservoirs. During that, your immune system is sputtering back to life. Since each blood work is only a snapshot of the time the blood was done and with so much changing going on, it can be more helpful to determine the state of your situation by looking at trends over several tests, and especially the cd4%. ARVs do nothing but stop HIV from using these up. So other numbers like the cd8 can be in flux while your cd4s are recovering. So look at the cd4% to determine if your treatment is working; because when that's working, you and your doctor will be able to determine if anything else is wrong and treat that issue accordingly. The cd4% is a slower changing marker about the health of your immune system. No matter the total cd4, that percentage creeping up for you is a good thing. the range for "normal" is 30% and above.

[leatherman]

DILS, google it, I got it, it was  not fun

damn, dude. You have really dealt with a lot of issues.... and you're still hanging in there. Kudos! 

[Mightysure]

I can give you my experience.  My CD8s are always elevated and my CD4s have never been below 750, making my CD4:CD8 ratio always slightly below the normal range.

My doctor says it's the product of HIV injection. CD8s are killer cells so it just means that your body is fighting an active injection, which for us, it is.

I wouldn't be too concerned about it and please remain adherent to your medication and hopefully you'll be in a healthy CD4 range in no time!

[Charles.M]

I just got back my lab results and I am feeling abit frustrated. I have been on treatment for 4 months and I know numbers jump around abit naturally still tough for me to take in.

After 2 months I went from CD4@72 to CD4@163, I thought I was doing really well. After 4 months CD4@162, not much of a drop but I was really hoping for an increase.

Also after 2 months my CD8 went from slightly elevated @ 1266 to a whopping 2248! After 4 months that at least came down to 1800 (still way off the chart). I am having a quite a bit of muscle and joint pain, which is far more prevelant when I try to sleep and in the AM. I do get going and working around the house and the pain subsides or i am just to involed in things that i don't notice it as much. I am going to see my PCP in a few weeks and am going to discuss this.

I know CD4 increases can be a slow process, but mentally its very hard not to see any gain. The joint and muscle inflamation is very hard as well, I honestly forgot what a good nights sleep even is.

Does the joint and muscle inflamation come from having high CD8 counts? Sorry for the rant just feeling abit low right now.

[Tonny2]

              ojo.         Helli there!!…do you know your cd4%?….the main issue is that you are UD, you should be happy about it. There are a lot of members here that it takes years for their cd4 increase above 200, so please relax, you dont want to know how long it took me to get to UD, everybody is different, remember that your med is working the rest it will come with time…good luck

[Jim Allen]

Hiya, I'm sorry you are frustrated by the lab results.

I don't have much to add from my last post on this, but the results look great; you are UD, and the other results are heading in the correct direction within such a short amount of time.

If I could, I would give you some of my CD4s, but mine are feckless and don't measure overall health. If you want to do something to help yourself, focus on the things inside your control, not the numbers! Take your meds daily, don’t smoke, eat a healthy diet, exercise, drink less alcohol, and get other issues you may have treated. 

Also, it will take some time for your immune system to heal and your results to settle, it's not uncommon to feel worse before things get better and you are only a few months into this journey. Keep working with your doctor, and know that you are not alone; we're here for you. If you ever need to chat one-on-one, just let me know.

[leatherman]

After 2 months I went from CD4@72 to CD4@163, I thought I was doing really well. After 4 months CD4@162, not much of a drop but I was really hoping for an increase.

Evaluating cd4 results should not be just about numbers but what these numbers mean for day2day life and/or simply being healthy living with HIV.

1. Never ever use a single data point. Always evaluate the trend of at least 3 tests over at least 3-6 months.
in 6 months, your cd4s when from 72 to 163. That's a positive upward trend.

2. Consider the full possible range of change.
since cd4s can change by 100 points in a single day, your cd4s have moved in a positive trend somewhere from the range of (0-175) to (60-265). Just think, if you had only exercised more, or less; or not rushed to the doctors office; or been less nervous, stressed, depressed or repressed; or had the blood draw 3 hours later or earlier, you might have had that 265 count.....you also could have had the 60. But based on the upward trend of the absolute count, you're definitively leaning in the 265 direction

3. Consider other factors.
What was your health and healthy habits before HIV? Have you been living a healthy lifestyle recently? Do you have any other medical issues? All these things can contribute or hinder the length of the recovery of you immune system. Of course, we can't forget age. Being older simply makes being healthier harder. Recovery, from any disease or damage, takes longer the older a person gets.

4. The science of UD.
If you stay UD by taking your daily meds, I bet I can make a 100% correct prediction for your future -- Your cd4s will continue to go up! The science says ARVs stop HIV and CD4 are able to recover. The catch though is that the trajectory of that recovery, the length of the recovery, and the upper limit of that recovery are based on your genetics, your age, your prior health, your current health, and the damage done by HIV. That unpredictability can be a bugger to deal with mentally; but science really does say that things will get better.

[Charles.M]

              ojo.         Helli there!!…do you know your cd4%?….the main issue is that you are UD, you should be happy about it. There are a lot of members here that it takes years for their cd4 increase above 200, so please relax, you dont want to know how long it took me to get to UD, everybody is different, remember that your med is working the rest it will come with time…good luck

Yes my percent is 7% i stared at 4% so its going up slowly, likely because of a drop in CD8.

[Tonny2]

Yes my percent is 7% i stared at 4% so its going up slowly, likely because of a drop in CD8.

M.          ojo.      Well, i guess your cd4% its a sign of progress, you need to relax and keep busy, we, whom have been diagnosed with “full blown AIDS”, know how you feel, it’s just matter of time for your soldiers to recover  after fighting the invaders in your body, be patient , you are on your way to full recovery…hugs