Question
Does unprotected sex affect CD4 count?
13 March 2012. Related: All topics, Resistance, Starting treatment.
Both my partner and I are positive.
I recently did my blood test and my CD4 count has dropped from 515 to 112 in a year. I was informed that I had to start medication.
He is not on meds as yet. We try our best to practice safe sex. But can this cause me to become resistant or continue lowering my CD4
Please assist.
Answer
Thank you for your question.
I am sorry your CD4 count has dropped so quickly fast. The good news in that, your CD4 will increase back to where is was, or higher in some cases, once you start treatment. You may find it useful to read our guide An introduction to combination therapy. The guide explains how treatment works, in more detail.
It is good that you do your best to use protection when you have sex. Unprotected sex will not affect your CD4 count. There is a small chance of resistance. However, this is only an issue if you have a different strain of HIV from your partner. If both of you have the same strain then the main risk of having unprotected sex would be STIs (Sexually Transmitted Infections).
Although HIV positive people can be re-infected with a different type of HIV, the risk of this is probably lower than the risk of catching HIV when you are HIV negative.
On another note, can I ask if both you and your partner are in contact with support groups for positive people? Many find it helpful to share experiences and ways of coping with living with HIV.
You did not specify where you live. However, if you did want to make contact with support groups, your doctor will be able to refer you to one in your area.
My wife is positive and I’m negative for almost four years now, and her CD4 is 390. Can we have direct sex without been infected
Hi Mbalie
As your question is about a new subject, I answered this as a new question here:
http://i-base.info/qa/10159
Hi i am HIV positive. jst found out dat my cd4 count is low and was affected by Guillain-Barre syndrome. I can’t walk bt sensation is there. I jst started treatment ARVs wil i recover from it?
In my experience meds are effective and my VL has been undetectable since starting treatment. In my case my CD4 results have not responded as I would of expected, so it seems that where X4 virus is more dominant CD4 levels take longer to improve.
I have read studies that confirm that over time there is no significancant difference in CD4 improvements. It has also to be said that our individual response to infection is very varied.
HIV drugs will all work just as well whether you have R5 or X4 virus, although pure X4 virus is rare and there is more usually a mixture, often with X4 at very low levels. The only drugs that will not work will be CCR5 inhibitors like maraviroc.
I’m not sure whether CD4 responses may be lower, but treatment itself should be just as effective.
Hi Simon,
In that case, does this mean that people who have the X4 virus will not respond to treatment very well? I am asking this based on Chris’ statement that his CD4 has never been higher than 290.
Hi Chris
I think it more likely that you just were unlucky and progressed quickly, and tat your recent absolute CD4 counts are relatively low given your percentage. A CD4% of 20 is usually a CD4 count of 350 – though this is variable. You might find over time the CD4 count normalises in relation to the percentage again.
Here is a link to a couple of studies from last weeks conference in Seattle.
The first reports high rates of detection of X4 virus using more sensitive tests, and also the complications of reinfection and dual infection.
http://www.retroconference.org/2012b/Abstracts/43004.htm
The second is a case of someone infections with X4 virus who was genetically protected from R5 infection because he has the delta-32 double mutation.
http://www.retroconference.org/2012b/Abstracts/43778.htm
Here are a couple of historical papers referencing faster CD4 decline with X4 (then called SI) but there are a lot of other paper that are easy to find online:
http://www.ncbi.nlm.nih.gov/pubmed/8096374.1
http://www.ncbi.nlm.nih.gov/pubmed/8096374.1
Now you are on treatment though I would not worry about this, especially as your CD4% puts you at a count over 300.
Hi there Simon – thanks for your reply, interesting stuff.
I can confirm that my CD4% also took a dive at the same time and both have consistently mirrored each other (% figure being much less volatile as expected)
Current CD4% is 19.1 and over the past 2 years has been relatively stable between 17 and 19%.
All this said I have never been unwell, fewer colds than some of my friends that have good CD4 results.
I was just intriuged by the “re-infection” hypothesis, I think the stored blood results came back as inconclusive for tropism as my VL was never very high, and naturally undetecatble twice prior to meds.
This leads me to think I had a good immune response to keep the virus at bay -perhaps it was a high level of immune response that depleted my CD4 count.
If you have any links to this kind of stuff I would appreciate reading more
Hi Chris
Although the majority of infections are with CCR5 virus (more than 90%) some people can be infected with CXCR4 virus. You are right that this is the type of HIV that develops in late infection and that this is linked to faster HIV progression.
Because infection can occur with X4, reinfection could also occur with X4. Some recent studies using sensitive tests to detect this, including at the Retrovirus conference in Seattle last week, suggested that the risk of reinfection might be as high as the risk of initial infection.
If your clinic has stored blood samples, it might be possible to test to see whether your virus was R5 at diagnosis and X4 when you started treatment. This might not mean that this came from reinfection though. The range of responses to HIV infection is so broad that some people are just unlucky and HIV progresses extremely quickly. If this was the case for you – it is based on genetics more that the type of virus – then this could just have been a natural rapid evolution from R5 to X4 as part of a single infection.
Cases of rapid progression include where this can occur within months and certainly within a year, so you have just been unlucky. If you didn’t already do this, it might be worth having a genotypic tropism test on a stored sample to see whether you had X4 virus when you started treatment.
Has your CD4 percentage also dropped over the same time?
Is there any documented evidence of being re-infected with X4 tropic virus (which I have read tends to be more common in established infections rather than recent infection)?
About 12 months after diagnoss my CD4 crashed from 800 to under 300 in the space of 3 months, and despite meds, has never been higher than 290. My consultant seems to think the crash is as a result of my virus becoming X4 synctium inducing virus.