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 Scarlett, I am sorry to hear about your situation. Do you have any support from friends and/or family?
Has a doctor said you are to wait for ART? WHO guidelines recommend that while Tb needs to be addressed immediately, starting ART should be a priority and no more than 2 weeks – this is of more importance given your CD4 count.
Other than ART, keeping healthy will require input from your medical team given your complexity. Have you been started on any other medication other than that for Tb? While your CD4 count is low you are at risk of other infections which you can take antibiotics to prevent.
Hi everyone,my Cd4 count is currently on 5 and im wondering if i might recover also now i have been diagnosed with TB and diaherae and i lost a lot of weight.I can’t start treatment yet as i need to recover.
In the meantime what can i do to keep healthy?
Hi Jose, thank you for sharing your story. It is really important that experiences like this are shared. It helps let people know others have been in their situation and offers a sense of hope – often which is rarely seen when everything appears rather bleak.
There is hope. I was diagnosed at age 32, CD4 count at 5, yes 5 :( + Kaposi sarcoma. In 8 months after dolutegravir+tenifovir/lamivudine my cd4 was at 253… in a year I was at 385, Kaposi gone in 3 months, all lesions in my gums completely gone. Lesions in back scared and clearly inactive, after a year I don’t even have scars. Lots of sun, sea every morning, ran 10k everyday. Lots and lots of celery, carrot, beet, apple, broccoli, aloe Vera and spinach juices. Used to mix every vegetable in a blender for breakfast. Meditation, meditation, meditation, and faith that I was going to heal.
Hi Christian, please don’t worry about anything. Your results so far are perfect. It is very common to take a longer time for your CD4 count to become higher when starting with such a low CD4 count. It is better that this increases slowly and steadily than to jump higher very quickly. Increasing by about 100 a year is the average when starting this low. Even if it takes many more years to reach 500, or even if you don’t get this high, the meds will help you to have a long and healthy life :)
Hello,
I got an AIDS diagnosis in May of 2019, with a CD4 count of 0 and a viral load of 300,000. I just got lab work done this past Monday and my CD4 count is 225 and my viral load is undetectable. While I am happy with the results I know a normal reading is supposed to be over 500. Will my immune system ever fully go back to normal?
Hi Meena,
It’s good to see that your CD4 count has risen. To know for sure if your meds are working, you’d need your viral load results, do you know what your viral load is?
My cd4 increase 279 to 320 after 5month treatment can my treatment is effective
Hi Steave,
What does your doctor say about your weight loss? And how much weight have you lost in total? Please discuss this with your doctor so you can find out what’s causing it.
Some HIV meds are not easy to take if you’re working shifts. So please let us know what meds you’re on. And please tell us your viral load results too.
A CD4 count of 636 is within the normal range for someone who is HIV negative.
I AM HIV POSITIVE,I STARTED TREATMENT ON 22 MAY THIS YEAR,MY CD4 COUNT IS 636 BUT DONT KNOW MY WEIGHT GOES DOWN,ON 22 MAY MY WEIGHT IS 60 KG,NOW AFTER 2 MONTHS TREATMENT MY WEIGHT IS 56..WHAT SHOULD I DO.I ALSO PERFORM SHIFTING DUTY.PLEASE HELP.