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 Thomas,
In some clinics you may be given ARVs without having your CD4 confirmed. However, you’d need to be diagnosed as positive for this to happen.
Is it possible to get ARVs treatment without checking CD4
Hi,
A persons CD4 count can only rise if they are on ARVs. Being undetectable has nothing to do with a persons CD4 count. Being undetectable is about a persons viral load.
Is it possible to recover cd4 without talking arvs.whe it’s undetected
Hi Jane,
I’m really sorry to hear this. Is there a reason why your friend will not start treatment? Do you know of any local peer support groups who can talk to them?
Perhaps asking at the clinic for support might help. As you can see from the question above, people start treatment at any CD4 count. But they have to be ready to start. And talking more about it can help a lot.
There’s much more information on the i-Base site. ART in Pictures is a good guide to how HIV treatment (ART) works.
My friend has 0Tcells. Will not do treatment. Has AIDS. How long will my friend live?
Hi Vinaydevapuji,
Have you started HIV meds (ARVs)? Starting ARVs with a CD4 count below 200 usually means that you’ll be taking antibiotics and other meds to stop or prevent other infections.
Once you start ARVs your viral load will reduce dramatically. This will give your CD4 count the chance to recover. But it’s a good idea to talk to the doctor about taking other meds to keep away infections during the recovery.
Sir my cd4 is 37 h how manage it
Hi Yeoj,
To know if your CD4 count has risen, you’ll need to have it tested. Is this possible? As your CD4 count is low, you should ideally be following the advice that’s given in this link: http://i-base.info/qa/4643
I am infected with HIV and my cd4 is only 8, how will i know if its already increase back to normal? I already taking meds for 2months now.