Friday, April 11, 2014

My Low CD4: TheBody's Opinion

In my last blog, I emailed my latest CD4 result, which to me was still very low. I felt sad about the slow increase in my CD4, to be honest, and starting to be disheartened. So, I asked TheBody's doctors regarding their opinions. Here's their response.

Low CD4
Apr 9, 2014

My baseline CD4 in June 2013 before I started ARV was 14. After 10 months of ARV, it's now 93. I have no Viral Load results yet. I will get my first VL result in 2 weeks. Here's my trend:

Date - CD4 Count - CD4% - Lymphocyte Count - WBC: June, 2013 - 14 CD4 - 1.77% - 774 - no WBC data; Sept, 2013 - 90 CD4 - no data - no data - no data; Dec, 2013 - 77 CD4 - 4.98% - 1548 - 5.14; Apr, 2014 - 93 CD4 - 8.32% - 1116 - 4.2;

My latest CD4 is only slightly higher, though my CD4% almost doubled, but lympocyte and WBC are lower. 

Could it be because I had colds 2 weeks before the test, and if I had no colds, my CD4 could have been higher?

After reading your past responses, I would expect that my VL is now undetectable (having been on ARV for 10 months). Now, I'm worried that with an undetectable VL, my CD4 would then rise even slower? If so, do you think it's likely that that I could reach 200 within 2014?

Also, my doctor advised me to refrain from going to public places until my CD4 rebounds to 200. If it can't be avoided, he advised me to wear a mask in public place. Is it really that high risk for people with CD4 of 93 to occasionally go out in public places like restaurants, fitness gym, or uncrowded cinemas, or even fly in a plane?
Response from Dr. Young
Hello and thank you for posting.

Your CD4 count results are excellent ones an indicate your initial immune system recovery from very advanced illness. The CD4 percentage rise is often the most reliable marker of change and the increase from 1.8% to 8.3% is entirely consistent with a strong virologic response. Having a respiratory tract infection can indeed influence CD4 counts, especially the absolute count. For this reason, I generally don't recommend having the test done within a couple of weeks of any acute illness-- you do fall right on the edge of this timeline.

CD4 counts typically increase about 150-250 cells in the first year of treatment- sometimes less for people who start treatment with low counts like you.

Why hasn't a viral load test been done? Do you live outside of North America or Western Europe? Many places outside of high-income countries do not yet have viral load tests, though they have been recently recommended for monitoring by the World Health Organization for all countries.

As for going into public places, I don't share your doctor's concerns. If you're on treatment, have an increasing CD4 count (and presumably undetectable viral load), your risk is not significantly elevated. Just wash your hands from time to time with soap and water- this will decrease the risk of common colds and the like.

Be well, BY

Dr. Young's response was very encouraging. It put me in high spirit again :) My immune recovery is excellent, and I should be happy about it. Regarding going to public places, yes, I agree that perhaps the environments in first world countries are different from the Philippines, and this could be the reason why my HIV doctor didn't want me to go as much to public places without a mask.  But in any case, I don't plan to go to crowded malls, like Megamall and Trinoma just to stroll. I'm fine with occasionally going to uncrowded new malls like Century City, Aura, Jazz Mall, or even to popular malls as long as it's very early or very late to avoid crowd. And I always bring alcohol in my pocket anyway. I'll wait for my VL result. Hoping for an undetectable level. 

Again, sometimes, I tend to forget that I had a very advanced AIDS illness upon diagnosis. A mere recovery from all my major and serious AIDS OI's is miracle enough... a battle against death. And the improvement that I had so far from a CD4% of only 1.8% to 8.3% is something that can be considered already as remarkable! So, this should be enough encouragement for me!