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 Ralph,
CD4 counts can go up or down. Stress, and minor infections like colds, can affect your CD4 count. But what HIV treatment are you taking? What’s your viral load result? Your viral load result is a better guide to how well your treatment is going.
Hi guys,, need your advice.. When I was detected my CD4 count was 22 only.. But at the time I didnt feel anything normal just my weight went low to 60kg so I decided to have an HIV test. that was December 2015. So our doctors requires us to update our cd4 and cbc every 6 months.. last March 2018 my cd4 count was stagnant at 252. it didnt went high nor low. But right now I just got my result and went down to 200…maybe because of stress casino is giving me because I play most of the time and cant deny that when you lose it giving you stress…..
Hi Myra,
Many treatment guidelines around the world now recommend starting HIV treatment (called ART) at any CD4 count. That’s because the START study showed that HIV treatment has important benefits for your health, even if your CD4 count is still high. Please see this link. It’s a good idea to talk to your doctor about this and discuss starting ART when you think you are ready.
I just found out that i am infected with HIV. My CD4 count is 515 and doctor said I dont have to take medicine as my CD4 count is still high.Please advise.
Hi Koketso,
I’m sorry that you’re feeling very sick. But are you back on your meds now? Have you talked to the doctors about taking different meds as you weren’t able to keep on with the old ones?
You can see from the answer above that many people have been able to recover to higher CD4 levels after treatment. So it’s a good idea to talk to the clinic about what meds will be best for you now.
pls help …my cd 4 count is 1 ..i defaulted my meds n now im very sik
Hi Samuel,
Yes you can recover.You will however need to restart medication. Is this something that is possible? If you can tell me which country you’re in I’ll be able to tell you if you can access medication for free. Given that your count has dropped you should also if possible following the advice here:
http://i-base.info/qa/4643
My CD4 count has gone from 280 to 43.I had to give up meds because I lost my job.Can I recover?
Hi Toby,
Having a CD4 count of between 500-600 is great. There’s nothing wrong with this at all. Your CD4 count could simply be fluctuating, and this is normal. Please see here:
http://i-base.info/qa/424
If you have any concerns you should speak to the trial manager.
I have been on arvs since 2006, when I started my cd4 was 40 and viral load in their thousands. Over the years my cd4 has remained between 500 and 600, I am a fitness expect training 6 days a week. My doctor says my cd4 remains in its range due to the fact that it was badly damaged when I started treatment 2006, this is stressful to me as I do everything by the book. I started clinical trials in March this year for the injection, I’m not on injection yet, but we give our bloods for cd4 checks and viral load monthly, I still take my Atripla, our bloods are tested in the UK and we are in South Africa. My issue is everytime our results come monthly they are way different, sometimes my cd4 will be in the 400s and next month 600 and down the next month. The doctor says the different readings could be because of the blood transiting to the UK, is this possible???. I’m worried as I am as healthy as a horse, never sick and I am a fitness expert appearing in health magazines, please help put me at ease