Q and A

Question

Why don't CD4 counts return to pre-infection levels?

Why cant a HIV+ person’s CD4 levels get back up to the same levels that existed before infection when reaching undetectable on antiretrovirals?

Answer

Hello,

Thank-you for your question.

The response a person has to HIV is very individual, and different people will see different results. The first aim of treatment is to achieve an undetectable viral load. The second is to increase CD4, particularly to above 200 to prevent opportunistic infections. Of course everybody would love to see their CD4 count return to pre-infection levels, but this doesn’t always happen. In truth we don’t know for certain why this is but I will do my best to explain some of the most likely explanations.

Try picturing your immune system as being similar to a computer keyboard. Each of the letters and numbers on the keyboard represents a different immune response. When you have all of the letters your immune system is strong and you can fight off all kinds of infections. When HIV enters the system it attacks the different parts of the immune system. You might lose a few of the keys on the keyboard, making you vulnerable to different infections.

The immune system is clever though. Imagine trying to write the word HELLO if you’ve lost your ‘L’. You could write HE11O. It’s not quite the same but it still gets the job done.

So although your immune system may lose certain responses it can often make up for this in other ways. While certain parts are permanently lost- and CD4 counts are not fully rebuilt- this doesn’t meant the immune system couldn’t work.

Some people are luckier than others and remain healthy even when their CD4 is quite low. This could be because they still have enough of the most important immune cells to combat key infections. Others might get ill at higher CD4 counts because they’ve lost some of the more useful immune cells. Like everything in HIV this is very individual and difficult to predict.

While it’s a good idea to keep an eye on your CD4 count it’s important not to get too hung up on numbers. If your viral load remains undetectable this means you will be able to keep taking your treatment. So long as you feel well and you are happy with your treatment that’s the main thing.

For more information about CD4 counts and other information around HIV treatment take a look at our ‘Introduction to Combination Therapy’ guide. You can view it online or download it from this link.

Please let us know if we can help further, or again in the future.

Comment

Your email address will not be published. Required fields are marked *