Question
What would happen if somebody starts with 0 CD4 count and on entry inhibitor?
22 July 2009. Related: All topics, CD4 and viral load, Cure.
What would happen if you started ARVs with an entry inhibitor if you had 0 CD4 count for a couple of months and you have not had ARVs before? I know, there is a very big risk of OIs, but would the immune system recover over time?
If there are no CD4 cells then the virus has nowhere to go and may be latent virus would then wake up in search of cells to infect.
Also, how about using HDACs? Or maybe transfusion of healthy blood? Or a combination of those with valporoic acid?
Answer
Unless the person is resistant to other classes of medicines, there is no particular reason of why he/she should start on an entry inhibitor.
If you have a very low CD4 count, even if it comes back as zero, it does not mean that your body have no immune cells. Only 2% of CD4 cells are in the blood – most are in the lymph system – and although it is not good to have a count that low, many people have been able to recover to higher levels after treatment.
Entry inhibitors do not prevent infection of CD4 cells on their own. They need to be used in combination with other ARVs. That is why, their particular usefulness in the situation that you describe is not huge. In addition, the only approved ones-enfuvirtide is taken in the form of injection twice daily and needs to be kept in the fridge. The other one-maraviroc (some people would classify it as a CCR5 inhibitor) is a bit problematic as before starting it, one needs a special test that is very expensive. All of that may turn to be a significant difficulty for somebody who is just starting treatment.
HDACs (Histone Deacetylase Inhibitors) affect the gene expression and are divided into four major groups. Their possible use is very far away from reality, as there are no enough data on how they will affect the body generally. They most probably will be linked to severe side effects and they most probably may be more useful with other conditions and not HIV-infection.
Blood transfusion will only lead to more opportunity for the virus to replicate and thus increase the viral load. Hence this strategy is not very promising.
As for valproic acid, here is an interesting article that you may find useful.
Hi Amanyire, HIV is a virus that is still with you, even with a high CD4 count and an undetectable viral load. It is important to still continue taking meds. If you stop, the virus will come back at much higher levels.
I have over 700 cd4 count do I still have HIV
Hi Salmina, it is great that you have an undetectable viral load. How long have you been on treatment?
A CD4 count of 9 is very low and means you have a vulnerable immune system. Have you also been given a medication called co-trimoxazole? This is an antibiotic used to prevent other infections while your immune system recovers.
Unlike viral load which responds quickly to HIV treatment, CD4 count recovery is slow and the lower the initial count the slower the recovery time. Was this your first CD4 count test?
More information about CD4 count: https://i-base.info/cd4-count/
Hi I have cd4 of 9 with undetectable viral load what should I do
Hi Mommy, thanks for writing about your son. If he is not taking HIV meds, it might be tht his CD4 count is now 110 as his viral load is likely to be much higher – see:
https://i-base.info/guides/starting/two-essential-blood-tests
The main problem though comes from your son not taking treatment. Whatever the cause of the skin problems, these would likely clear up just by taking HIV meds again.
Do you know why he doesn’t want to take treatment? If it is because he had difficult side effects with previous HIV meds, there are newer drugs that he might find easy to take.
Does your son realise how serious HIV can be once the CD4 count is below 200? Is there a reason he doesn’t even want the skin lesions to get better?
Without more information it is difficult to comment. For example, how old is he and when did he become HIV positive. Does he know other people who are also positive. What does the clinic and doctor say? Are they able to help?
I found out my son was not taking his medicine in 2019. His viral load went to 110 he have not taken the medicine every sense now he has rashes and lesions on his body. He refused to take the medicine. What does the lesions mean I have two sons that I have to protect
Hi Mulugeta, I have not come across ‘Xxx’ as a result.
Even if a CD4 count is depleted the result should be ‘0’. Possibly this means there was an error in your test and a follow-up test is required?
Did you doctor explain to you what this result meant?
I got Xxx result in Cd4 count what is indicated