Question
Is this immunological failure?
5 March 2013. Related: All topics, CD4 and viral load.
I have been on ART for 12 years. My CD4 count falls down from 840 to 709 to 578 within 15 months.
But my VL is undectable till today. My dr says that it is IMMUNOGICAL FAIL . Is it correct to change the combination?
Answer
Hi,
Thank-you for your email.
In the UK, if you had an unexpected change in your CD4 count, this would be checked against your CD4 percentage. It’s normal for CD4 counts to fluctuate- go up and down- and CD4 count tests can have a large margin of error. CD4 counts tend to vary a lot- especially at high levels like this.
The CD4 percentage is a more stable measurement of how many CD4 cells you have in comparison to your other immune cells. If this is relatively stable then the decrease in your CD4 count is unlikely to be significant.
When you’re on treatment the most important thing is that your viral load stays undetectable. This means that the virus isn’t able to replicate and therefore can’t damage your immune system further.
Because your CD4 count is still very good, and your viral load is undetectable, you shouldn’t worry, and changing treatment isn’t necessary.
I would be interested to know which drugs you are taking though, if you have been on the same treatment for 12 years. It’s possible that there are newer drugs available which could have fewer side effects. Can you tell me what treatment you’re on?
Immunological failure refers to the results of a CD4 blood test, which is a marker of your immune system. If your CD4 count is going down by a significant amount when you are taking HIV meds, this is sometimes referred to as immunological failure.
Virological failure is when viral load rebounds to detectable levels, or never becomes undetectable when taking treatment.
Virological failure usually occurs first, then, if treatment is not changed, resistance continues to develop and immunological failure occurs later.
But what does immunological failure mean? And how/why does it happen?