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 Melinda, I am sorry to hear about your memory loss. Have your doctors investigated for possible reasons about why you are having problems with your memory and also the anaemia? Do you know what the cause of your anaemia is?
Is there a reason you defaulted with your ARVs for 6 months? It is good that you have now restarted. Have you checked your viral load to see that your treatment is still working?
How much weight have you lost? and when did you first notice it? Have you noticed any other symptoms like night sweats or fevers.
I am on ARVs but defaulted for 6 months and developed anaemia . I,ve had blood transfusions every 6 months( 3 transfusions already) I now gone back to ARVs but suffer from memory loss and lost weight for sometime now.
Hi Brady, it is great that you now have a suppressed viral load. Do you know your CD4%? Sometimes the number for CD4 count is not always accurate.
I was diagnosed last 26th of May 2022 and my CD4 was 126.
CD4 22march 2023= 255
CD4 9 Oct 2023= 207
Viral load:
18 Nov 2022= 172
9 June 2023 = less than 40
Hi Charles, is there a reason your sister is not taking medication? has she been on treatment before? and do you know if she has had her viral load tested?
Please I need your assistance asap. My young sister hasn’t been taking her medication for the past 4 years and she has a zero cd4 count. How can she be assisted. I have posted my email address.
Hi Puseletso, you didn’t say what your CD4 count is right now. My response will be very different depending on if this is high or low.
Once you are on treatment, the viral load test is more important than the CD4 count. Viral load needs to become undetectable.
Please send your rough viral load and CD4 count so I can answer in more detail.
I am using trenvir since 2020 but my cd4 count is not improving, what can be the cause and what can I do to improve my CD4 count?
Hi Gideon, does your sister know why she needs to take her medication? had she experienced side effects or problems with when she was last on treatment?
the situation is just worsening she really refused to take the tabs am really confused