Key tests for monitoring the health of an HIV-positive person: CD4 cell count and viral load. AIDS test How many cells per year are lost with HIV

CD4 cells are T-lymphocytes that have CD4 receptors on their surface.
general information). This subpopulation of lymphocytes is also called T-helpers. Along
with viral load, the level of CD4 cells is the most important auxiliary marker,
used in HIV medicine. It serves as the most reliable risk assessment criterion.
development of AIDS. The results obtained can be roughly classified into two
groups: above 400-500 cells / μl - corresponds to a low incidence of severe
manifestations of AIDS, below 200 cells / μl - accompanied by a significant increase
the risk of developing manifestations of AIDS with an increase in the duration of immunosuppression.
However, most often AIDS-related diseases develop at the level of CD4
less than 100 cells/µl.
When determining the level of CD4 cells (most often by flowcytometry), one should
take into account several factors. Relatively fresh should be used for analysis.
blood, the collection of which was carried out no more than 18 hours ago. Depending on laboratory
conditions, the lower limit of the normal range is 400 to 500 cells/µl.
The basic rule about viral load assessment also applies to viral load analysis.
CD4 cells: always use the same laboratory
(having experience in performing such analyses). The higher the value, the higher it
fluctuations, so deviations of 50-100 CD4 cells / μl are quite possible. In one of
studies at a real value of the level of CD4 500 cells / µl 95% confidence
the range was from 297 to 841 cells/µl. At 200 cells/µl 95%
the confidence interval was 118 to 337 cells/µl (Hoover 1993).
If an unexpected CD4 count is obtained, the analysis must be repeated. Should
remember that in the presence of an undetectable viral load, even a pronounced decrease
the level of CD4 cells should not cause concern. In such cases, you can refer
on the relative number of CD4 cells (percentage), as well as on the ratio
CD4/CD8 as relative rates are usually more reliable and less susceptible to
fluctuations. As a rough guide, you can use
the following values: with a CD4 level of more than 500 cells/µl, one would expect that
the relative value will be more than 29%, with a CD4 cell level of less than 200 cells / μl
it will be below 14%. In addition, the reference values ​​of the relative indicators and
ratios vary, depending on the laboratory. When significant
discrepancies between absolute and relative indicators of CD4 cells should be
be careful in making therapeutic decisions - it is better to do it again
control analysis! Other indicators of the blood test should also be taken into account, including
including the presence of leukopenia or leukocytosis.
Doctors today often forget that the results of a CD4 cell count are
vital. The road to the doctor and a conversation about the results of the examination for many
patients is a huge stress (“it’s worse than before the exam”), and the choice
an incorrect methodology for reporting presumably negative results can
lead to reactive depression. Therefore, it is essential to inform the patient about
physiological and methodologically determined fluctuations in the results of the analysis.
A drop from 1200 cells/µl to 900 cells/µl most of the time doesn't matter! And many
patients, on the contrary, will perceive the message of such results as
catastrophe. You should also try to reduce euphoria in patients with unexpected
good scores. This will save the doctor from explanations and losses for a long time.
time, as well as from feelings of guilt for the unjustified hopes of the patient. fundamental
the problem should be considered the communication of test results by employees related to
nurses (they do not have fundamental knowledge about
HIV infection).
With the initial achievement of a normal CD4 level and sufficient suppression
virus replication, it is permissible to perform an analysis every six months. Probability of re-
reduction in CD4 levels below 350 cells/µl is low (Phillips 2003). Falling below
a clinically significant border of 200 cells/µl is generally observed extremely rarely. According to
the results of one of the new studies, the likelihood of this phenomenon in patients,
single CD4 300 cells/µl and viral load suppression below
200 copies/ml, less than 1% over 4 years (Gale 2013). For this reason, the measurement
CD4 count in stable patients is no longer recommended in the US
(Whitlock 2013). Patients who still wish to have more frequent check-ups
immune status, in most cases can be reassured by the phrase that with the level
nothing bad can happen to CD4 cells as long as suppression is maintained
virus replication.

Figure 2: Reduction in absolute and relative (dashed line) CD4 cell count in
untreated patients. On the left is a patient suffering from HIV infection for almost 10 years,
pay attention to the pronounced fluctuations in the indicator. On the right is a patient who, for 6
months, there was a sharp decline in CD4 levels from over 300 cells/µl to 50 cells/µl. At
patient developed AIDS (cerebral toxoplasmosis), which could probably be
prevent by timely initiation of ART. This case is a clear argument in
the benefit of regular monitoring, even with presumably good performance.

Factors affecting the indicator
Along with methodologically determined fluctuations, there are a number of other
factors affecting this laboratory indicator. These include
intercurrent infections, leukopenia of various origins, immunosuppressive therapy.
Against the background of opportunistic infections, as well as syphilis, the number of cells
CD4 is reduced (Kofoed 2006, Palacios 2007). Also to the temporary reduction of this
indicator are significant physical activity (marathon running), surgical
intervention or pregnancy. Even the time of day may play a role: during the day, the level of CD4
low, then it rises and reaches a maximum in the evening, around 20.00 (Malone 1990).
The role of mental stress, which is often referred to by patients, in contrast, is
insignificant.

Most untreated patients experience relatively continuous
decrease in the level of CD4 cells. However, there is a variant of an abrupt flow
disease in which, after a period of relative stability, there is rapid
Decreased CD4 count - Figure 2 shows one such case. According to
analysis of the COHERE database, which includes 34,384 naive
HIV-infected patient, the average annual decrease in CD4 levels was
78 cells/µl (95% confidence interval - 76-80 cells/µl). Drop amplitude
had a close relationship with the magnitude of the viral load. With an increase in viral load
1 Log showed a decrease in CD4 levels of 38 cells/μl/year (COHERE 2014). Links with
gender, ethnicity of the patient, or active drug use
has not been identified, despite its alleged existence.
The rise in CD4 cells with ART is often biphasic (Renaud 1999, Le
Moing 2002): after a rapid rise in the first 3-4 months, the rate of increase in the level of cells
CD4 is down. In one study with nearly 1,000 patients,
in the first 3 months, the monthly rise in CD4 levels was 21 cells/µl. During
the next 21 months, the monthly rise in CD4 levels was only 5.5 cells/µl
(LeMoing 2002). The rapid growth of CD4 cells at the initial stage is probably due to their
redistribution in the body. Then the active production process joins
naive T cells (Pakker 1998). It may also play a role in the early stages
decrease in the intensity of apoptosis (Roger 2002).
There is ongoing debate as to whether restoring the immune system is
against the background of long-term suppression of viral replication is continuous, or it continues
only 3-4 years, reaching a plateau phase with no further rise (Smith 2004, Viard
2004). The degree of recovery of the immune system is affected by a number of different factors.
An important role is played by the degree of suppression of viral replication: the lower the viral load,
the better the effect (Le Moing 2002). And the higher the CD4 count at the time of initiation of ART, the
higher their absolute growth in the future (Kaufmann 2000). In addition, in the long term
restoration of the immune system, including naive T-cells,
available initially (Notermans 1999).


Figure 3: Raising absolute (solid line) and relative (dashed line) quantity
CD4 cells in two previously treated patients. Arrows indicate the time of initiation of ART.
In both cases, fairly pronounced fluctuations are observed, the amplitude of which is sometimes
reaches 200 CD4 cells or more. Patients should be told that individual values
indicators do not carry much information.


Figure 4: Dynamics of viral load (dashed line, right axis, logarithmic
data presentation) and absolute (dark line) CD4 cell count over a long-term
ART. On the left - at the initial stage, there were significant problems of adherence to treatment,
only after the development of AIDS in 1999 (TBC, NHL) did the patient start taking regular ARP, which
was accompanied by a rapid and adequate restoration of immunity, in the last 10 years
plateau level is maintained. The question to be asked is to what extent the measurement should be continued.
CD4 level. On the right - an elderly patient (60 years old) who made 2 breaks in treatment and has
moderate restoration of immunity.

In addition, the age of the patient is of great importance (Grabar 2004). The larger the dimensions
thymus and more active thymopoiesis, the more significant will be the increase in the level of CD4 cells (Kolte
2002). Due to the fact that thymus degeneration is often observed with age, the process
Elevated CD4 counts in older adults are not the same as in younger patients
(Viard 2001). However, we have seen patients with poor recovery dynamics
CD4 levels already at the age of 20 and, conversely, 60-year-old patients with extremely good dynamics
recovery. The ability of the immune system to regenerate is characterized sharply
pronounced individual differences, and until now there are no methods
allowing to predict this ability with sufficient reliability.
There are probably certain antiretroviral regimens, for example,
DDI + tenofovir, in the application of which the immune recovery will be less
pronounced compared to others. In some modern studies
it was found that a particularly good recovery is observed against the background of taking
CCR5 antagonists. It is also necessary to pay attention to the associated
immunosuppressive therapy, which can affect the recovery process
immunity.

Practical Guidelines for Monitoring CD4 Cell Levels
 The basic principle is the same as for measuring viral load: tests should be
performed in the same laboratory (having the necessary experience).
 The higher the indicators, the more pronounced the fluctuations (you should take into account the many
additional factors) - you should always look at the relative indicators and
CD4/CD8 ratio compared to baseline!
 Don't go crazy (and don't let patients go crazy) on the expected decline
CD4 levels: with sufficient suppression of the viral load, a decrease in this
indicator may not be due to the progression of HIV infection! take care
nerves! In case of extremely unexpected results, the analysis should be repeated.
 When the viral load drops to an undetectable level, analysis of the cell level
CD4 is sufficient to perform once every three months.
 With a pronounced suppression of viral replication and a normal level of CD4,
apparently, it is also possible to reduce the frequency of monitoring this indicator (but to the viral
load does not apply!). Its value as an auxiliary marker of the current
infection in a stable patient is controversial
 In untreated patients, CD4 cell count remains the most important
auxiliary marker!
 CD4 counts and viral load should be discussed with your doctor. The patient is not
should be left alone with the results of the examination.

Information about the further typical dynamics of the level of CD4 cells is presented in the section
Principles of treatment. So there are studies on the detailed study of the function of cells
CD4 as part of the qualitative ability of the immune system to fight against specific
antigens (Telenti 2002). However, these methods are not required for use in
standard diagnostics, so far their usefulness has been considered questionable. When-
someday they may help to identify the few patients who have
risk of developing opportunistic infections even with normal cell levels
CD4. Two more examples from practice will be presented below, reflecting the dynamics
immune status and viral load during long-term therapy.

Regular monitoring (checking) of CD4 cell count and viral load is a good indicator of how HIV is affecting the body. Physicians interpret test results in the context of what they know about HIV patterns.

For example, the risk of developing opportunistic infections is directly related to the number of CD4 cells. Viral load levels can predict how quickly CD4 levels may fall. When these two results are considered together, it is possible to predict how high the risk of getting AIDS in the next few years is.

Based on your CD4 count and viral load tests, you and your doctor can decide when to start ARV (AntiRetroviral) therapy, or treatment to prevent opportunistic disease.

CD4 cells, sometimes called helper T cells, are white blood cells that are responsible for the body's immune response to bacterial, fungal, and viral infections.

Number of CD4 cells in people without HIV

The normal number of CD-4 cells in an HIV-negative man is between 400 and 1600 per cubic millimeter of blood. The number of CD-4 cells in an HIV-negative woman is usually slightly higher - from 500 to 1600. Even if a person does not have HIV, the number of CD-4 cells in his body depends on many factors.

For example, it is known that:

  • In women, the level of CD4 is higher than in men (by about 100 units);
  • Level 4 in women can fluctuate depending on the phase of the menstrual cycle;
  • Oral contraceptives may lower CD-4 levels in women;
  • Smokers typically have lower CD-4 counts than non-smokers (by about 140 units);
  • The level of CD-4 falls after rest - fluctuations can be within 40%;
  • After a good night's sleep, CD4 counts can drop significantly in the morning but rise during the day.

None of these factors seem to affect the ability of the immune system to fight infections. Only a small number of CD-4 cells are found in the blood. The rest - in the lymph nodes and tissues of the body; therefore, these fluctuations can be explained by the movement of CD-4 cells between the blood and tissues of the body.

Number of CD-4 cells in HIV-infected people

After infection, the level of CD-4 drops sharply, and then it is set at the level of 500-600 cells. It is believed that people whose CD-4 levels initially fall faster and stabilize at a lower level than others are more likely to develop HIV infection.

Even when a person has no obvious symptoms of HIV, millions of their CD-4 cells become infected and die every day, while millions more are produced by the body and stand up for the body.

It is estimated that without treatment, the CD4 cell count of an HIV-positive person drops by about 45 cells every six months, with more CD4 cell loss seen in people with higher CD4 counts. When the number of CD4 cells reaches 200-500, this means that the person's immune system has been harmed. A sharp drop in CD4 count is observed about a year before the onset of AIDS, which is why it is necessary to regularly monitor the CD4 level from the moment it reaches 350. The CD4 level will also help decide whether to take medications to prevent certain diseases associated with the AIDS stage.

For example, if the CD4 count is below 200, antibiotics are recommended to prevent infectious pneumonia.

CD4 count can fluctuate, so don't pay too much attention to the result of one test. It is better to pay attention to the trend in the number of CD4 cells. If the CD4 count is high, the person is asymptomatic, and is not on ARVs, then they likely need to have their CD4 count checked every few months. But, if the CD4 count drops sharply, if the person is in clinical trials for new medications, or is taking ARVs, then they should check their CD4 count more frequently.

Number of CD4 cells

Sometimes doctors not only study the nominal number of CD4 cells, but also determine what percentage of all white blood cells are CD4 cells. This is called determining the percentage of CD4 cells. The normal result of such a test in a person with an intact immune system is about 40%, and the percentage of CD4 cells below 20% means the same risk of getting a disease associated with the AIDS stage.

CD4 level and ARV therapy

CD4 can serve to determine the need to start ARV therapy and as an indicator of how effective it is. When the CD4 count drops to 350, the doctor should help the person determine if they need to start ARV therapy. Doctors recommend that a person start ARV therapy when their CD4 count drops to 250-200 cells. Such a level of CD4 cells means that a person is in real danger of getting AIDS, an associated disease. It is also believed that if you start ARV therapy when the CD4 count has fallen below 200, then the person “responds” to treatment worse. But, at the same time, it is known that there is no benefit from starting therapy when the CD-4 cell level is above 350.

When a person starts taking ARVs, their CD4 count should slowly start to increase. If the results of several tests show that the CD4 level is still falling, this should alert the doctor, inform him that it is necessary to reconsider the form of ARV therapy.

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HIV+ FORUMS Taking therapy

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bobcat2
Quote

Quote
Truvada and Efavirenz.
VN is not defined.



bobcat2
Russia, St. Petersburg Added: 20-01-2011 21:31
Quote

In fact, this topic has been discussed many times before. A brief plot of similar topics: the absence of an immunological effect against the background of complete suppression of viral replication at the beginning of treatment at the stage of AIDS

Quote
I have been in therapy for a year and a half now.
Truvada and Efavirenz.
SD as it was 110 cells. so it's worth it.
VN is not defined.
For now, I'm not going to change the plan. After all, virological success is evident.
And the SD, although low, is stable.

There is only one recommendation in this regard: a review of the arv regimen with the replacement of an NNRTI with a ritonavir-boosted protease inhibitor. However, the effect is difficult to reproduce - in some it gives impetus to an increase in the absolute number of CD4 lymphocytes, in others it does not.
What about those who have extremely low values ​​on a ritonavir-boosted protease inhibitor without an upward trend?

1) Adding to the Fusion scheme. Not applicable due to unavailability

2) 4th drug option, e.g. prezista/ritonavir + isentress + 2 NRTIs

However, if the first approach, if not a de facto standard, but quite successfully used in Europe, the second, just like the replacement of NNRTIs with PIs, may or may not give an impetus. There are currently no randomized controlled trials of this kind, the approach should be considered empirical.
However, given that low SI values ​​are in themselves associated with a high risk of mortality, this may be the case, and if it is possible to receive these drugs, then one should try.

Undoubtedly, it is necessary to try. But you should be prepared for the fact that these approaches may not work. Example:

How to boost immunity in HIV?

At the heart of such a disease as HIV lies, first of all, the weakening of the body and disruption of the immune system. We will learn about how to increase immunity in HIV in this article.

How does the immune system work?

Knowing how the defense mechanisms of our body work is very important when detecting HIV and, moreover, when diagnosing an infection such as AIDS.

Immunity with HIV is significantly weakened, which worsens the patient's health every day, making him completely defenseless against surrounding microbes and diseases.

The work of the immune system is headed by white blood cells or leukocytes, which are able to destroy all kinds of accumulations of viruses and bacteria that attack our body. These white blood cells and their performance in blood tests are very important for recognizing all sorts of disorders in the immune system. Normally, in healthy people, their level, with the development of any infection, increases.

Also an important indicator of the functioning of the immune system of the human body is the presence of cells such as T- and B-lymphocytes. They help produce special antibodies to resist the development of the disease.

And CD4 cells play the most important role in maintaining and functioning of the immune system. As a result of HIV infection and active replication of viruses, the number of these cells gradually decreases, the body can no longer resist the infection, and as a result, AIDS develops. Such a failure of the body must be prevented as early as possible, from the time of the establishment of HIV infection.

What can help boost immunity in HIV?

Raising immunity in HIV is very important and necessary. And this process is not for one day or a week. To stimulate the immune system in humans, a number of rules and recommendations have been developed and highlighted, the regular observance of which allows you to strengthen the immune system, resist viruses and bacteria, and delay the transition of HIV to AIDS as much as possible.

How to raise immunity in HIV, we will consider below. Here are the basic rules:

  1. Lead a consistently healthy lifestyle. This aspect includes several points - this is quitting smoking, alcohol, as well as regular exercise, prolonged exposure to fresh air, hardening.
  2. It is equally important to eat right and rationally.. The point of a healthy diet is to stimulate the immune system with the consumption of wholesome foods high in vitamin content. It is also desirable to do this every day. For the body with HIV, it is important to consume vegetables and fruits, cereals and meat. The amount of food should be moderate (without preservatives and additives), varied.
  3. Research confirms that excessive stress and the experiences of people do not at all help strengthen the immune system, do not increase the number of protective cells in the body, but rather provoke and worsen the course of this disease. Therefore, the important point is to avoid unnecessary worries and worries, to try to be as calm as possible about emerging problems.
  4. Sufficient hours of sleep, also help to strengthen the immune system in case of HIV disease, resist this infection, and also stimulate the work of cells to protect against bacteria and viruses.

Medicines to boost immunity

Much and often is written about how to competently strengthen the defenses of a sick body. And most people perfectly understand and know all these recommendations. The main point is that with HIV and AIDS, simply observing them is not always enough. Really right methods are needed that help to restrain the development of the disease together.

It is for such purposes that special medicines are produced. Let's talk about which of them are the most common and available:

  1. Interferon inducers. These are drugs that can stimulate in people the synthesis of a special protein, Interferon, which will suppress the development of viruses and their damage to body cells. Most often, drugs such as Cycloferon, Viferon, Genferon, Arbidol, Amiksin and many others help to raise the body's immunity with HIV.
  2. Medicines of microbial origin. They are based on the active resistance of the body to HIV and other diseases, by activating the work of its own defense system. They contain a small amount of components of certain bacteria, which encourages the body's immune system to work and protect itself. The most famous and more often prescribed are Likopid, Imudon, Bronchomunal and others.
  3. Herbal preparations. Their effectiveness lies in the fact that, if they are used regularly, they help strengthen the immune system and activate it to fight against viruses and bacterial cells. Examples of drugs: Immunal, Echinacea, Ginseng and others.

It is important to remember that HIV is not just a cold. This is a rather severe immune disorder and, more correctly, the destruction of the body. Therefore, any self-administration of drugs may not give the expected effect at all. All medicines against viruses and bacteria, to stimulate the work of protective blood cells, must be used only after agreement with the attending doctor. The danger lies in the fact that with HIV you can cause irreparable harm to yourself with any drug!

Traditional medicine for the strength of the immune system

Numerous studies show that regular intake of vitamin C every day helps to boost immunity. And the importance of this moment is that only vitamin C will not be enough for our disease. It is desirable and even necessary every day to stimulate cells against numerous viruses to consume complexes of preparations with a large dose of vitamin B, A, E, C and many others, as well as minerals.

A large number of various useful substances and vitamins can be found in simple folk and affordable remedies and recipes. For example, fruit drinks and infusions, compotes and decoctions of cranberries, lingonberries, lemons.

The fact that herbal infusions and their various collections help to boost immunity and prevent various diseases is evidenced by many studies in the field of traditional medicine. The most recommended for the pathology under consideration is a decoction of flax, lime blossom, lemon balm, St. John's wort and many others.

Do not forget that there is such a miracle cure as garlic, which is also evidenced by research and observation. Its regular consumption is very useful for preventing the progression and development of any cold, including HIV.

Summing up, I would like to note once again that it is important to strengthen the immune system reasonably, without fanaticism, coordinating all points with the attending doctor so that it brings unambiguous benefits.

how to increase cells in hiv

I will continue about the treatment of HIV infection. Let me remind you of the three main goals of treatment:

1. First of all, reduce the amount of virus in the blood below the detection level (this was the previous post).
2. Increase (or at least not lose) the number of CD4 cells.
3. Make sure that with all this the person feels good (or at least bearable). Because if a person feels bad, he will finish the treatment sooner or later. I will pay attention to this point, because it might seem that everything, there are medicines, there is success, something to worry about. In fact, drugs can damage health in the long run (for example, slowly kill the kidneys) and cause significant inconvenience every day.

If everything is more or less clear with the viral load (the virus should not be determined in the blood on an ongoing basis, which should be achieved after a maximum of 6 months), then there are no clear criteria for assessing the success of treatment in terms of CD4 cells. The most streamlined formulation sounds like this - the treatment is successful if the CD4 cells have grown. But how much they should grow up, no one can say for sure. At 50? at 100? Become over 200 (to protect against AIDS markers) or over 500 (to approach the immune status of HIV-negatives)?
It is easier to assess failure - if the cells began to fall during treatment, something must be done about it. In general, it is clear why there are no clear estimates. It is difficult to predict how the immune system will recover concrete person. And most importantly, it is almost impossible to influence this process from the outside. There are, of course, successful attempts and schemes, science is working in this direction, but there is no such thing at the level of every clinic and every infectious disease specialist, there is no such thing yet.

Just like the viral load, the number of CD4 cells changes in 2 phases: first quickly, then slowly. One study shows that, on average, CD4 cells grew by 21 cells per month for the first three months, and then by 5 per month thereafter. Other data say that in the first year of treatment, the number of cells grew by 100.

Doctors are still arguing Is there a recovery limit for the immune system? If the number of cells grows, will it always be like this, or will they eventually reach their maximum? A delicate question, because it is important from the point of view of “do I need to change the drug or is that all, the limit, you can calm down.” While it is believed that both options are possible:
1. Slow but steady increase in the number of CD4 cells.
2. Achievement of a certain level (it is difficult to predict exactly which one) and after that growth stops.

On what can you base your prediction?

1. Unfortunately, statistics show that the lower the level of CD4 cells begins treatment, the less likely they are to grow to 500. But the good news is that for CD4 cells, any reduction in viral load is already a plus . The less virus in the blood, the more chances they have to stay alive. And the more cells, the lower the person's risk of developing an infection or tumor. Therefore, even if the drugs fail to finally “squeeze” the virus, treatment should be continued in order to preserve your immunological army.

2. The age of the patient plays a role. As a rule, the younger a person is, the faster and better his immune system is restored. Although I was told about one grandfather who did not know about HIV-positiveness until he was admitted to the hospital with an AIDS marker disease. The prognosis was not very good: age over 60, CD4 count less than 150. Treatment started, grandfather reacted very well. CD4 counts have risen to 500. Grandfather is now over 70, everything is ok. This example shows well how different our organisms are and how an individual person can be despite all the statistics.

3. The presence of other diseases. Cirrhosis of the liver plays a negative role, immunological diseases also have a negative effect. Hidden infections such as tuberculosis can worsen (or even make themselves felt in the first place) against the backdrop of a revived immune system, which also causes trouble. It seems that according to the analyzes everything is going well, but the person is getting worse. Already started coughing.

4. Was the person treated before or not. It is believed that the best immune response is in those who have never been treated. For those who interrupted treatment, CD4 cells fall and do not rise to the previous maximum level. That is, by interrupting treatment, a person leaves less and less chances for a normal immune system.

There are situations when one of the goals of therapy is achieved, and the other is not. For example, the level of the virus drops below the level of detection, and the cells do not grow much. Or vice versa, the cells grow well, but the virus still won't give up. The first situation happens more often: thanks to the pills, the virus is not detected, but CD4 counts do not increase much. Even despite the new drugs, this situation occurs in almost a quarter of patients. So far, doctors are not completely clear what to do about it.
One of the obvious solutions is to revise the treatment regimen, but there is no clear understanding of when to do this, how and whether it is necessary at all (addiction to new drugs, new side effects - all this increases the risk of stopping treatment by the patient). In addition, studies show that there is no proven effectiveness of this method. In general, they try to take into account the toxicity of certain drugs so that their treatment does not completely kill CD4 cells. And if CD4 cells remain below 250-350 for a long time, then antimicrobial drugs are added to the treatment in the form of prevention of AIDS marker diseases.

One of the main issues in the treatment of HIV infection is When exactly should treatment be started? At first glance, everything is very simple. The lower the CD4, the sooner death will come, which means the sooner treatment should be started. In reality, everything is more complicated. It is necessary to take into account the toxicity of drugs. Let's just say, a year of life with bouts of diarrhea - you can imagine. What about 20 years old? Given that diarrhea is not the biggest problem that arises from treatment. The threat of a kidney transplant or life on dialysis is much more serious.
Do not forget about the financial resources of the country. Treat 200 people or treat 1000 people a year - there is a difference. Therefore, in poorer countries, treatment was started with 200 CD4 cells, in richer countries (America, for example) - with 500. Most countries still tend to think that 350 CD4 cells is already a solid indication for starting treatment. We are guided by 400 cells. Let me remind you that almost half of our patients begin treatment with 250 cells, although they could have done with 400 if they had arrived earlier. Based on everything written above, it’s a pity that they lose these 150 cells in conditions when the state agrees to treat them for free (yes, in Estonia it is. You get registered with an infectious disease specialist, once a month you come for medicines, you receive them against signature in a office from the hands of a nurse, 5 days a week, from 8 to 4. Such offices are located at polyclinic hospitals).

The last, but perhaps the most important point: whether the person is ready to be treated? It turns out that without a clear, conscious desire to be treated, there may be no point in rushing (in a situation where, for example, there are from 200 to 350 cells). Because it is dangerous to start and then interrupt treatment (the virus is not a fool, it mutates and will find protection from drugs, with its interruptions a person gives him a chance for this). Because the side effects that the doctor will not endure, but the person himself, every day. For example, most drugs are not compatible with alcohol. You know what a problem it is. The drugs must be taken 2 times a day, so it is difficult to find a moment to drink, sober up, and then a pill. One man tells us: “So when I drink, I don’t take pills, it will be bad for me. How often do I drink? Well, 2 times a month. And for how many days? well, 10 days.
Some tablets should be taken only at night, which is not suitable for those who work at night or in shifts. The first month or two will be especially unpleasant, the body will get used to it, the immune system will take wings, latent infections will wake up - all this is not for busy periods of life, not for vacations or holidays.
This is not counting purely medical factors - whether a person has anemia, whether there is C-hepatitis, how the kidneys work, etc.

In general, the beginning of treatment, the choice of drugs, the treatment itself is a purely individual matter. In each specific case, it is not analyzes that are considered, but a person and his specific life (infectionist patients have more than special lives). Therefore, the more time there is to make a decision, to talk with the doctor, the better. And it all depends on the immune status of a person and his knowledge of whether he has HIV or not. So, as usual, I will finish on what needs to be tested and tested, then there will be time for reflection.

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If therapy does not cause an increase in immunity?

Hello! We are writing to you because we are desperate to find at least some understanding in the AIDS center. The fact is that my husband has HIV and hepatitis C for more than 10 years. For ten years he has been going to the center, receiving therapy, but there are no significant improvements ((That is, at first (about a year later) immune cells grew to about 250 and the viral load disappeared. But then the progress stopped, the cells do not grow further. He took different therapies, we don’t remember all of them, but the improvement began only 1.5 years ago, with the new therapy atazanavir + lamivudine + abacavir. Cells grew to 400. But this therapy was canceled, motivated by the fact that everything is fine and you can take other drugs Changed to atazanavir + combivir, 7 months ago. Since then, everything has been worse ((and in the last analysis they found a viral load of 1000 ((The doctor told her husband that he probably doesn’t take pills, she has no other explanation (and prescribed 26 September My husband is depressed, I'm very worried, but it's useless to ask in the center, they don't want to talk ((Questions:
1. Why do cells not improve for so many years?
2. Why did they change the scheme that helped?
3. Should physicians at the center provide advice and monitor comorbidities?
4. Where to go for consultations on concomitant diseases, if everywhere they answer: well, what do you want, you know your diagnosis!
5. How can you help with lipodystrophy?
6. Is it right to take drugs for dysbacteriosis? There are no tests, but the symptoms ((
Please reply, we are very excited!

CD4 count(full name: CD4+ T cell count, or CD4+ T cell count, or T4, or immune status) is a blood test result that shows how many of these cells are in a cubic millimeter of blood.

The CD4 count is a very good "surrogate marker". It indicates how severely HIV has affected the immune system, what is the depth of the infectious process, what is the risk of other infections, when should treatment be started. The average number of CD4 cells for an HIV-negative person ranges from 600 to 1900 cells/ml of blood, although this level may be higher or lower in some people.

    2-3 weeks after infection, the CD4 count usually drops.

    As the immune system begins to resist, the CD4 count rises again, although not to its original level.

    In the future, over the years, the number of CD4 gradually decreases. The average annual decline in CD4 counts is about 50 cells/mm3. For each individual, this rate is individual, depends on many factors, such as the subtype of the virus, the age of the person, the route of HIV transmission, genetic characteristics (presence or absence of CCR5 receptors) and may be higher or lower.

The immune system of most people successfully controls HIV without requiring treatment for many years.

CD4+ Cell Count is a blood test that measures how well the immune system is functioning in people with the human immunodeficiency virus (HIV). CD4+ cells are a type of white blood cell. Leukocytes play an important role in the fight against infections. CD4+ cells are also called T lymphocytes, T cells, or T helpers.

HIV infects CD4+ cells. The CD4+ cell count helps determine if other infections (opportunistic infections) may occur. The trend of the CD4+ cell count is more important than the value of a single test, because it can change from day to day. The trend of CD4+ cell count over time demonstrates the effect of the virus on the immune system. In untreated HIV-infected people, the CD4+ cell count usually decreases as HIV progresses. A low CD4+ count often indicates a weakened immune system and a higher chance of developing opportunistic infections.

Why testing is done

The measurement of the CD4+ cell count is carried out in order to:

    Observing how HIV infection affects your immune system.

    Help to diagnose Acquired Immune Deficiency Syndrome (AIDS) in time. HIV leads to AIDS, a long-term chronic illness with no cure.

    Determining when is the best time to start antiretroviral therapy, which will reduce the rate of HIV infection in the body. For more information, see the "Results" section.

    Determine your risk of developing other infections (opportunistic infections).

    Determine when is the best time to start preventive treatment for opportunistic infections, such as taking medication to prevent Pneumocystis Pneumonia (PCP).

The CD4+ cell count determined at the time you were diagnosed with HIV serves as a baseline against which all subsequent CD4+ cell counts will be compared. Your CD4+ count will be measured every 3-6 months, depending on your health, previous CD4+ count, and whether you are taking highly active antiretroviral therapy (HAART).

How to prepare for the test

Before taking this test, consult a specialist who will advise you on the meaning of the test results. Find out how this test is related to your HIV infection.

How the test is done

The health worker conducting the blood draw will perform the following steps:

    Put an elastic band around your arm above the elbow to stop the blood flow. This enlarges the veins that are below the level of the dressing, making it easier for the needle to enter the vein.

    Wipe the needle with alcohol.

    Insert a needle into a vein. More than one attempt may be needed.

    Attach a blood sampling tube to the needle.

    When the required amount of blood has collected, he will remove the bandage from your arm.

    Apply a gauze compress or cotton swab to the skin puncture site with a needle after removing it.

    First, he will press the puncture site, and then apply a bandage.

What will it feel like

You may not feel anything during the injection, or you may feel some pain as the needle passes through your skin. Some people experience burning pain while the needle is in the vein. However, most people experience no (or minimal) discomfort while inserting a needle into a vein. Your pain will depend on the skill of the healthcare professional taking the blood sample, as well as the condition of your veins and your sensitivity to pain.

Lymphocytes are one of the types of white blood cells. Lymphocytes make up approximately 15 to 40% of white blood cells. And they are one of the most important cells in the immune system, as they protect you from viral infections, help other cells fight off bacterial and fungal infections; produce antibodies, fight cancer, and coordinate the activities of other cells in the immune system.

The two main types of lymphocytes are B cells and T cells. B cells are created and mature in the bone marrow, while T cells are created in the bone marrow but mature in the thymus ("T" stands for "thymus" or "thymus gland"). B cells produce antibodies. Antibodies help the body destroy abnormal cells and infectious organisms such as bacteria, viruses, and fungi.

T cells are divided into three groups:

T-helpers(from English to help - “help”; also called T4 or CD4 + cells) help other cells destroy infecting organisms.

T-suppressors(from English to suppress - “suppress”; also called T8 or CD8 + cells) inhibit the activity of other lymphocytes so that they do not destroy healthy tissue.

T-killers(from English to kill - “kill”; also called cytotoxic T-lymphocytes or CTLs and are another type of T8 or CD8 + cell) recognize and destroy abnormal or infected cells.

"C" and "D" in CD4 stand for cluster of differentiation - "cluster of differentiation" and denote a cluster of proteins that make up cell surface receptors. There are dozens of different types of clusters, but the most common ones we talk about are CD4 and CD8.

What is the CD4 count?

T4 cells. CD4+ cells. T-helpers. Regardless of the name, if you are HIV positive, then these are the cells that are important to you (Note: when we talk about "T cells", we will always refer to CD4 cells in the following). Knowing the number of CD4 cells in a person's blood, which is determined Blood tests ordered by a doctor can tell you how healthy your immune system is and how well it is fighting HIV. It is also useful to know the CD4 count when deciding when to start antiretroviral (ARV) therapy and whether to start anti-AIDS drugs.

The task of CD4 cells is to “notify” other cells of the immune system that it is necessary to fight this or that infection in the body. They are also the main target of HIV, which is why their number decreases over time. If there are too few CD4 cells, then this means that the immune system is not working as it should.

The normal number of CD4 cells is between 500 and 1500 cells per cubic millimeter of blood (that's about a drop). In the absence of specific HIV treatment, the number of CD4 cells decreases by an average of 50–100 cells each year. If the number of CD4 cells is less than 200, a person may develop AIDS-associated diseases (opportunistic infections), such as pneumocystis pneumonia. And if their level falls below 50-100 cells, then a huge number of other infections can develop. For this reason, specific drugs to prevent these infections (prophylactic treatment) are started as soon as the CD4 count drops below a certain level, such as 200 in the case of Pneumocystis pneumonia.

When combined with a viral load test, your CD4 count will also help you figure out when to start ART. Most experts agree that ARV therapy should be started as soon as a diagnosis is made.

What is the proportion of CD4 lymphocytes?

In the form of the results of clinical and laboratory research, you can see the column "proportion of CD4 + lymphocytes (%)". This indicator is of great importance for you and your doctor. In a healthy adult, CD4 cells make up 32% to 68% of total lymphocytes, a large group of white blood cells that include CD4 cells, CD8 cells (see below), and B cells. Essentially, in the laboratory, the number of CD4 cells in a blood sample is determined by the proportion of CD4 cells.

Often the CD4 count is more accurate than directly measuring the number of CD4 cells in a blood sample because it does not vary as much from analysis to analysis. For example, the number of human CD4 lymphocytes can vary from 200 to 300 over several months, while the proportion of CD4 lymphocytes remains constant at, say, 21%. As long as the CD4 count remains at or above 21%, the immune system functions normally, regardless of the specific number of CD4 cells. On the other hand, if the CD4 count does not exceed 13%, regardless of the specific CD4 count, it usually means that the immune system is damaged and it is time to start prophylactic treatment (drugs for disease prevention) to prevent opportunistic infections such as pneumocystis pneumonia .

What is CD8 cell count and T cell ratio?

CD8 cells, also called T8 cells, play an important role in fighting infections such as HIV. A healthy adult usually has 150 to 1000 CD8 cells per cubic millimeter of blood. Unlike CD4 cells, people living with HIV tend to have larger than average CD8 cells. Unfortunately, no one knows exactly why. Therefore, the results of this analysis are rarely used in making treatment decisions.

Clinical laboratory results may also indicate the T cell ratio (CD4+/CD8+), that is, the number of CD4 cells divided by the number of CD8 cells. Since the CD4 cell count in people living with HIV is usually lower than usual and the CD8 cell count is usually higher, the ratio is usually low. The normal ratio is usually between 0.9 and 6.0. As well as CD8 cells. Some experts believe that the inverse ratio in people living with HIV is a kind of double whammy from HIV. On the one hand, it promotes the death and renewal of T cells, which ultimately reduces the level of CD4 cells. On the other hand, because the immune system is constantly fighting inflammation due to the virus, the number of CD8 cells is chronically high. However, most experts agree that if the T-cell ratio increases with the start of ARV therapy (i.e., the CD4 count rises and the CD8 count falls), then this is a clear sign that drug treatment is working.

What do the results of a T-cell test look like?

Absolute and percentage T-cell counts are usually listed in the "Lymphocyte Subset" or "T-Cell Group" section. It is there that the values ​​of various lymphocytes in your body (CD3+, CD4+ and CD8+), as well as other immune cells, are listed. This test is often referred to as a complete blood count. Below is an example of a standard T-cell test result sheet.

Definitions of some of the terms used in the T cell assay

Absolute CD3+ count

The CD3+ count is the total number of T-lymphocytes, which are one type of white blood cell that matures in the thymus. These lymphocytes include T4 and T8 cells.

Percentage of CD3

The total number of T-lymphocytes (including T4 and T8 cells), expressed as a percentage of the total number of lymphocytes. These are white blood cells that mature and reside in the lymphoid organs of the body.

Number of T4 cells

The number of T4 cells per cubic millimeter of blood (that's about a drop). These are the white blood cells that prime the immune system to fight disease and are also a prime target for HIV. As HIV infection progresses, the number of T4 cells decreases from a normal value of 500-1500 cells to almost zero. When the number of T4 cells falls below 200, this means that there is an increased risk of developing opportunistic infections, and when their number falls below 50, the risk increases dramatically.

Percentage of T4

The number of T-lymphocytes, expressed as a percentage of the total number of lymphocytes. These are white blood cells that mature and reside in the lymphoid organs of the body. The percentage of T4 cells is often more accurate than a direct T4 count because it does not vary as much from analysis to analysis.

Number of T8 cells

The number of T8 cells per cubic millimeter of blood (that's about a drop). Although they are called suppressors on most test forms, they actually include both suppressors and killer T cells (see definitions above). T8 cell counts are typically elevated in people with HIV, but because little is known about why this is the case, these test results are rarely used in treatment decisions.

Percentage of T8

The number of T8 lymphocytes, expressed as a percentage of the total number of lymphocytes. These are white blood cells that mature and reside in the lymphoid organs of the body. Often, the percentage of T8 cells is more accurate than the direct calculation of the number of T8 lymphocytes, because it does not vary as much from analysis to analysis.

T cell ratio

The number of T4 cells divided by the number of T8 cells. Since the number of T4 cells in people living with HIV is usually lower than usual, and the number of T8 cells is usually higher, their ratio is usually lower than usual. The normal ratio is usually between 0.9 and 6.0. As with T8 cells, no one knows exactly what a low value means. However, most experts agree that if the T-cell ratio increases with the start of ARV therapy (i.e., the number of T4 lymphocytes increases and the number of T8 lymphocytes falls), then this is a clear sign that drug treatment is working.

Since the discovery of the human immunodeficiency virus, serious progress has been made in the treatment. But until now, the infected and their loved ones are interested in the viral load in HIV, its indicators and the norm. These data are taken into account when selecting therapeutic methods that prolong years. In the absence of treatment, doctors predict up to 10 years of life for people with HIV, with the right treatment - up to 70. Not the last place in this study is occupied not only by antibodies to HIV infection, but also by the number of cells responsible for immunity, T-lymphocytes, or CD-4, - they can protect the infected from concomitant diseases leading to death, or AIDS. A general blood test, which is also prescribed for HIV, helps to clarify the situation. With a low level of antibodies to the virus, it is enough to be examined twice a year, with increased, during pregnancy, taking replaceable groups of antiretroviral drugs - once every 2-4 weeks - 3 months.

  • Diagnostics
    • polymerase chain reaction
    • Immunoblotting
  • Norms
  • What is immune status
  • Immune status and virus

Blood tests for human immunodeficiency virus

The study of biological material, which is blood, remains the most informative method. Before taking an HIV test, they try to take into account the behavior of the virus. It appears in plasma, although it is found in both seminal fluid and vaginal mucus. HIV analysis is a multicomponent diagnostics. Blood is taken for various studies:

  1. Blood test for HIV. Often, the virus is first detected during a blood test for HIV and hepatitis.
  2. A complete blood count is also prescribed for HIV. It will show specific indicators of leukocytes, platelets, hemoglobin, erythrocyte sedimentation rate (ESR). But these same nuances sometimes indicate other viral infections, in case of deviation from the norm, other blood tests are prescribed.

Important! If you do not know how HIV tests are done, on an empty stomach or not, doctors will answer: biological material is taken on an empty stomach. This provides a reliable result.

  1. Express tests for HIV. They give results within 30 minutes. They study not only blood, but also saliva, urine. The test is informative in terms of diagnosing infection and the amount of antibodies. Sometimes it happens that the HIV test is positive, the analysis is negative. The result is false negative if the infection has occurred recently. You will need to pass this examination after 6 weeks.
  2. enzyme immunoassay. Serum is isolated from the blood, where they look for antibodies to the human immunodeficiency virus. When asked by patients how long an HIV test is done, doctors answer: up to 10 days. But even here the possibility of erroneous results remains. This is influenced by autoimmune diseases, exacerbations of chronic diseases, cancerous tumors.

When thinking about where you can take an HIV test, you should contact a private laboratory, the centers for the prevention and control of AIDS and HIV, but the easiest way is to donate blood at a public clinic at your place of residence. Anonymity remains a positive aspect of every medical institution.

You can find out how much your AIDS test costs in advance. The price of an HIV test ranges from 300 to 12,000 rubles. Research in private laboratories and highly sensitive tests remain more expensive in terms of cost.

Diagnostics

Conventionally, diagnostic studies are divided into 2 types. The first group helps to determine the fact of infection. Such tests can establish control over the course of the infection, indicate the effectiveness of treatment.

The second group determines antibodies to the human immunodeficiency virus, p24 antigen (serological tests) and virus RNA, provirus DNA (molecular genetic tests).

A detailed diagnosis is prescribed after a general blood test has been carried out, which is desirable for HIV. HIV infection occurs in different stages: from an asymptomatic state to an acute phase, like AIDS. During it, the body suffers from opportunistic diseases, while the immunity of healthy people can resist them. This will be demonstrated by the general indicators of blood cells.

Diagnostics helps to determine the number of leukocytes. The future treatment and quality of life also depend on the ratio of them and antibodies to the virus. In addition to general methods, specific methods are also used.

polymerase chain reaction

This is one of the most effective methods for diagnosing infection. Its results are 90-99% true: the test does not detect antibodies to the virus, but its RNA. This HIV test is distinguished by short readiness periods - up to 3 days.

Immunoblotting

This is a highly sensitive and not the cheapest method for recognizing a viral infection. It consists in separating the proteins of the virus, after which they are transferred to a nitrocellulose membrane. After the electrophoresis procedure, its antigens, different in molecular weight, are compared with the samples on the test strip. The method shows at what stage of immunodeficiency a person is.

Norms

In a healthy person, the CD-4 immune index is 400-500 - 1600 cells / ml. If the figure decreases to 200-500, changes every six months by 45 units - the probability of infection is high. But the possibility of diseases that affect immune processes, pregnancy and breastfeeding in women is also taken into account.

Also, a blood test for HIV has norms for infected people. If the cell count has dropped to 350, it's time to start therapy. Due to this, concomitant diseases dangerous for infected people will not develop.

If the figure has dropped to 200 units, highly active antiretroviral therapy is often prescribed. Immunocompromised people are advised to get tested for HIV and hepatitis. Liver diseases are often accompanied by a dangerous virus, exacerbate the state of immunity.

Important! Half of the cases of infection are diagnosed after a blood test for hepatitis, rw and HIV has been carried out: after a woman is registered for pregnancy, during medical examinations, before donating blood.

The infected are not only interested in the value of CD-4. The number of dangerous virus particles in the blood plasma is important. The load may show an erroneous result due to a violation of the conditions for passing tests, after vaccinations, due to past diseases. This also applies to healthy people. But if in a month the indicator increases by 3-5 times, this is a reason to think.

Much depends on the state of health of the infected person. It is characterized by blood cells, in particular, those responsible for the fight against foreign bodies, including viral infections.

What is immune status

The totality of quantitative and qualitative indicators of immunity is the immune status. Its measurement is best done at the same time of day, in the same laboratory, using the same tests. The difference in them sometimes leads to false results.

Immune status and virus

The condition of an infected person depends on the ratio of the main indicators: the number of virus particles and CD-4 cells, immune status and viral load are mandatory parameters for diagnosis and possible treatment. The task of doctors is to increase the immune status that fights the virus. However, it is able to infect CD-4 cells, their number can drop sharply to a critical level. That is why the patient is periodically diagnosed.

Results and interpretation of analyzes

ELISA results may vary. They identify different protein compounds present in the envelopes of the virus. The sets of proteins in the test systems may differ, but if 3 main ones are found, the test will give a positive result.

Scientists identify the following indicators:

  • Up to 20 thousand copies / ml - insufficient concentration of RNA. For an infected person, this is a good result. A healthy indicator should be equal to zero.
  • From 20 thousand to 100 thousand - the middle stage, characterized by primary or secondary manifestations of immunodeficiency.
  • From 100 thousand to 450 thousand is considered a deadly indicator. The higher the number, the more likely you are to develop AIDS.

Important! You can re-donate blood with a false negative, false positive and incorrect result. A negative result is true if there was no risk of infection in the 12 weeks prior to blood sampling.

Ways of transmission of a viral infection

The cost of an HIV test makes it affordable for everyone. The urgency of the problem is confirmed by common methods of transmission of infection: this is the use of non-sterile medical instruments, in particular syringes, the way from mother to child, during unprotected intercourse, during blood transfusion.

When asked how long it takes to get tested for HIV after a possible infection, doctors answer: you need to wait from 3 weeks to 3-5 months.

What to do with the infected and their loved ones:

  1. Monitor the number of copies of the HIV RNA virus. This reduces the risk of infection by the mother of the fetus, and also increases the life expectancy of the infected.
  2. Timely take tests and responsibly take courses of antiretroviral therapy.
  3. Remember that not only the determination of the viral load in HIV is important indicators, their correlation with the results on the immune status is the main component of treatment. Tests are taken regularly.

Since there is no cure for the HIV virus, people with a viral load need to make sure that the viral particle count does not go beyond the normal range. Even with this diagnosis, you can continue to live a fulfilling life.