Question
Complications of Reiter's disease (reactive arthritis)
14 March 2008. Related: All topics, Living with HIV long-term, Opportunistic infections.
Hi i was diagnosed HIV+ in October 2003 my blood results & viral load were deemed very good with CD4 860 VL 50 and CD4% 42. Over the years of regular testing my CD4 has risen to a high of 960 but averaged at 700+ and my VL has mostly never risen above 100; my CD4% remained in the upper 30%.
In 2004 i developed severe pains in my left foot and lower limb which has progressivly worsened. After extensive testing i was told i was suffering with Rhiters Disease & osteo arthritis unseen before in a person of my age(34)
Though this has severly affected my mobility it didn’t seem to be affecting my CD4 count, CD4% or VL.
My consultant wanted to use steriod injectections as she said my immune response had gone into hyperdrive, but i was fearful that suppressing my immune response would allow the HIV to gain the upper hand. So i elected to pay for accupunture & reflexology sessions instead.
In 2007, the situation with my mobility worsened, affecting both feet and lower limbs. Reluctantly, i agreed to give the steriod injections a shot. Prior to injection my results remained quite good CD4 720, CD4% 32 and VL 118. After the injections things took a turn for the worse. My CD4 droped to 588 my VL went up slightly to 352 but the biggest drop was seen in my CD4% which droped to 16% = 50% drop.
My most recent results as of yesterday were CD4 618 VL 118 CD4% 13. Given that CD4 % of 13 would normally indicate an overal CD4 of around 180 my consultant is a little baffled. I’m also aware that when the CD4 % drops below 15% this increses the possibility of progression to AIDS!
My consultant has suggested two options:
1. Enroll in a case study using IL-7 injections to try to boost CD4%
2. Start ARVs
What should i do? Have you seen any other cases like me – ie reasonable CD4 count very low viral load, but plumitting CD4%? Does my current CD4 % 0f 13 reflect a more accurate picture of immune damage in this instance?
The consultant treating me for the Reiter’s…
Answer
Hi
this is a complicated question, and the end of your post may not have reached me. I think you were going to talk about the response of your Reiters consultant, and it would be useful if you can send this section again.
With any complication – Reiters syndrome – also more frequently called ‘reactive arthritis’ – is relatively rare and I’d want to know you are seeing a specialist for this.
There is little research about HIV and arthritis in general although it is a serious problem for those affected. HIV could be related to any inflammatory disease because of it’s effect on your immune system, but in your case you seem to be controlling HIV without treatment.
In this case, you may be a slow progressor – still having a CD4 count over 500 and a barely detectable viral load at least 4-5 years after infection. You could start ARVs, and this may improve the arthritis, but is may aslo not make any appreciable difference.
Against this background, the lower CD4% may not be important. It may not reflect any real change in your immune system, or being any indication of an increased risk of developing AIDS. For example, it could be a result of steroid treatment, or a local effect – ie CD% is reduced in blood but not in other parts of your body. This is something an expert should address.
I’d be interested in where you are treated. If it is a smaller clinic, and if they have little experience of HIV and arthritis, then your consultant seeking advice from one of the larger hospitals, or arrnaging for you to have a second opinion, may be the best idea.
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