Keeping more than just the doctor away
2007/08/20
An apple a day may keep the doctor away, but HIV positive patients need to keep more than just the doctor away, they need to keep their CD4 levels up in order to stay healthy.
For a healthy person, the CD4 count value is usually between 800 and 1 000 and the viral load is non-existent. However, a person with HIV will lose CD4 cells as the virus starts to work. The CD4 cells are those that fight infection, and the HI virus infects these very cells making it difficult for your body to fight infection. The higher the viral load, the faster you lose CD4 cells.
Soon after infection with HIV, the CD4 cell count will probably drop sharply, before stabilizing at around 500 – 600. It seems that people who experience a greater initial drop in CD4 cell count and a lower stabilisation in their CD4 cell count, may be at risk of the disease progressing faster and therefore developing AIDS sooner.
Even while they are well and have no obvious symptoms of HIV, millions of CD4 cells are both infected by the HI virus and lost every day, and millions more are produced to replace them. The body tries to keep a balance between the cells that are lost and the production of new cells. Soon these also become infected, and while the balancing act may continue for years, eventually the body cannot keep up and the levels of CD4 cells start to drop.
Without treatment, an HIV-positive person’s CD4 cell count drops by about 45 cells every six months. Checking the CD4 cell count provides a guide for the doctor when prescribing medication to prevent AIDS-defining illnesses such as tuberculosis or pneumonia.
Effective anti-HIV treatment results in a reduction in your viral load. Within about four weeks of starting HIV treatment, your doctor should test your viral load to see how much it has fallen.
The aim of treatment in people who have never taken anti-HIV drugs before, is to get the viral load to undetectable levels within 24 weeks (6 months). When your viral load falls, your CD4 cell count should begin to slowly increase and this is good for your health.
A CD4 cell count between 200 and 500 indicates that some damage to the immune system has occurred and the CD4 count drops sharply again before AIDS develops, so it is a good idea to have CD4 cell counts regularly monitored once it goes below 350.
The value can vary from one test to the next, so don’t rely too much on a single test result, rather look at the trend in a number of recent CD4 cell counts.
If you are healthy with a high CD4 count, you have no symptoms and are not taking anti-HIV medication, then your CD4 levels probably only need monitoring every four to six months. However, if it’s falling rapidly and you are unwell, are taking part in a clinical trial, or are taking anti-HIV drugs, then your CD4 count should be monitored more often.
When deciding on whether you should take HIV treatments, the health practitioner will take into consideration the length of time a person has been infected with HIV, the CD4 cell count and the viral load.
It is currently recommended that an infected person should start anti-HIV treatments immediately, especially if the virus is making them ill, or if they have an AIDS-defining illness. It is also a good idea to start treatment if the CD4 cell count is near or below 200, which is the level at which the body is not strong enough to fight off every serious AIDS-defining illness, nor is it able to prevent the immune system from rapidly becoming weaker.
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