Condition at low DM 4. What are CD4 cells - features, properties and recommendations

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 percentage of CD4 lymphocytes 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. Because 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.

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When does the AIDS stage begin?

In 2001, under the leadership of Academician of the Russian Academy of Medical Sciences V. I. Pokrovsky, a new edition of the domestic clinical classification of HIV infection was carried out.

Stage 1- "stage of incubation" - the period from the moment of infection to the appearance of the body's reaction in the form of clinical manifestations of acute infection and / or the production of antibodies. Its duration usually ranges from 3 weeks to 3 months, but in isolated cases it can be delayed up to a year. During this period, there is an active reproduction of HIV, but there are no clinical manifestations of the disease and antibodies to HIV have not yet been detected. Therefore, the diagnosis of HIV infection at this stage cannot be established by the traditional laboratory method. It can only be suspected on the basis of epidemiological data and confirmed in a laboratory study by the detection of the human immunodeficiency virus, its antigens, and nucleic acids in the patient's serum.

Stage 2- "stage of primary manifestations", associated with the manifestation of the primary response of the body to the introduction and replication of HIV in the form of clinical manifestations and / or the production of antibodies. The stage of primary manifestations of HIV infection can have several variants of the course:

* 2A - “asymptomatic”, characterized by the absence of any clinical manifestations of HIV infection. The body's response to the introduction of HIV is manifested only by the production of antibodies.
* 2B - "acute infection without secondary diseases", manifested by a variety of clinical symptoms. The most frequently recorded fever, rashes on the skin and mucous membranes (urticarial, papular, petechial), swollen lymph nodes, pharyngitis. There may be an increase in the liver, spleen, diarrhea. Sometimes aseptic meningitis develops, manifested by meningeal syndrome. In this case, during lumbar puncture, unchanged cerebrospinal fluid is usually obtained, flowing out under high pressure, occasionally there is a slight lymphocytosis in it. Similar clinical symptoms can be observed in many infectious diseases, especially in the so-called childhood infections. Sometimes this variant of the course is called a mononucleosis-like or rubella-like syndrome. In the blood of patients during this period, wide-plasma lymphocytes - mononuclear cells can be detected, which further enhances the similarity of this variant of the course of HIV infection with infectious mononucleosis. Bright mononucleosis-like or rubella-like symptoms are observed in 15-30% of patients. The rest have 1-2 of the above symptoms in any combination. In some patients, lesions of an autoimmune nature may be noted. With such a course of the stage of primary manifestations, a transient decrease in the level of CD4-lymphocytes is often noted.
*

2B - "acute infection with secondary diseases", characterized by a significant decrease in the level of CD4-lymphocytes. As a result, against the background of immunodeficiency, secondary diseases of various etiologies appear (candidiasis, herpes infection, etc.). Their manifestations, as a rule, are mild, short-term, respond well to therapy, but can be severe (candidal esophagitis, pneumocystis pneumonia), in rare cases even death is possible.

In general, the stage of primary manifestations, proceeding in the form of an acute infection (2B and 2C), is recorded in 50-90% of patients with HIV infection. The beginning of the stage of primary manifestations, proceeding in the form of an acute infection, as a rule, is noted in the first 3 months after infection. It can outpace seroconversion, that is, the appearance of antibodies to HIV. Therefore, at the first clinical symptoms in the patient's serum, antibodies to HIV proteins and glycoproteins can not be detected.

The duration of clinical manifestations in the second stage can vary from several days to several months, but usually they are recorded within 2-3 weeks. Clinical symptoms of the stage of primary manifestations of HIV infection may recur.

In general, the duration of the initial stage of HIV infection is one year from the onset of symptoms of acute infection or seroconversion. In prognostic terms, the asymptomatic course of the stage of primary manifestations of HIV infection is more favorable. The more severe and longer (more than 14 days) this stage proceeded, the greater the likelihood of rapid progression of HIV infection.

The stage of primary manifestations of HIV infection in the vast majority of patients passes into the subclinical stage, but in some patients it can immediately pass into the stage of secondary diseases.

Stage 3- "subclinical stage" is characterized by a slow increase in immunodeficiency, which is associated with compensation of the immune response due to modification and excessive reproduction of CD4 cells. The rate of reproduction of HIV during this period, compared with the stage of primary manifestations, slows down.

The main clinical manifestation of the subclinical stage is persistent generalized lymphadenopathy (PGL). It is characterized by an increase in at least two lymph nodes, in at least two unrelated groups (excluding inguinal), in adults up to a size in diameter of more than 1 cm, in children - more than 0.5 cm, remaining for at least 3 -x months. On examination, the lymph nodes are usually elastic, painless, not soldered to the surrounding tissue, the skin over them is not changed.

Enlargement of lymph nodes at this stage may not meet the criteria for PGL or may not be registered at all. On the other hand, such changes in the lymph nodes can also be observed in the later stages of HIV infection, in some cases they occur throughout the disease, but in the subclinical stage, enlarged lymph nodes are the only clinical manifestation.

The duration of the subclinical stage ranges from 2-3 to 20 years or more, but on average it lasts 6-7 years. The rate of decrease in the level of CD4-lymphocytes during this period averages 0.05-0.07x109/l per year.

Stage 4– “stage of secondary diseases”, associated with the depletion of the population of CD4 cells due to the ongoing replication of HIV. As a result, against the background of significant immunodeficiency, infectious and/or oncological secondary diseases develop. Their presence determines the clinical picture of the stage of secondary diseases.

Depending on the severity of secondary diseases, stages 4A, 4B, 4C are distinguished.

* 4A usually develops 6-10 years after infection. It is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, inflammatory diseases of the upper respiratory tract. Usually, stage 4A develops in patients with a CD4-lymphocyte level of 0.5-0.35x109/l (in healthy individuals, the number of CD4-lymphocytes ranges from 0.6-1.9x109/l).
* 4B often occurs 7-10 years after infection. Skin lesions during this period are deeper and tend to be protracted. Damage to internal organs begins to develop. There may be weight loss, fever, localized Kaposi's sarcoma, and peripheral nervous system involvement. Usually, stage 4B develops in patients with a CD4-lymphocyte level of 0.35-0.2x109/l.
* 4B is mainly detected after 10-12 years from the moment of infection. It is characterized by the development of severe, life-threatening secondary diseases, their generalized nature, and CNS damage. Usually stage 4B occurs when the level of CD4-lymphocytes is less than 0.2x109/l.

Despite the fact that the transition of HIV infection to the stage of secondary diseases is a manifestation of the depletion of the protective reserves of the body of an infected person, this process is reversible (at least for a while). Spontaneously or as a result of ongoing therapy, the clinical manifestations of secondary diseases may disappear. Therefore, in the stage of secondary diseases, the phases of progression (in the absence of antiretroviral therapy or against the background of antiretroviral therapy) and remission (spontaneous, after previous antiretroviral therapy or against the background of antiretroviral therapy) are distinguished.

Stage 5- "terminal stage", manifested by the irreversible course of secondary diseases. Even adequately conducted antiretroviral therapy and treatment of secondary diseases are ineffective. As a result, the patient dies within a few months. At this stage, the number of CD4 cells is usually below 0.05x109/l.

It should be noted that the clinical course of HIV infection is very diverse. The given data on the duration of individual stages of the disease are of an average nature and may have significant fluctuations.

Struck. Depending on the number of immune system structures that have a normal structure and perform their protective functions well, the need for antiretroviral therapy depends. A cell affected by AIDS is not able to fight the virus and is a source of reproduction of the pathogen, therefore, a specific treatment is prescribed that prevents the division of atypical structures and further damage to the human body.

HIV target cells

The most important criterion for assessing the pathogenicity of a virus in the body is the presence of healthy elements of the immune system. This indicator depends on the number of CD4 cells infected with HIV infection. With prolonged absence of AIDS treatment, an increase in the affected structures of HIV is observed. At the same time, few suppressor cells are produced by the body, which is associated with the detrimental effect of any infectious pathogens.

The main destructive effect of the retrovirus is directed at the cd4 immune structures. HIV infects these elements in order to reduce the innate ability of the body to give a full-fledged protective response to the pathogenic action of the pathogen in the body of the infected person.

Depending on the quantitative destruction of immunity, in particular cd4 cells, HIV infection affects certain organs and their systems, causing a characteristic clinical picture.

Classification of HIV according to DM 4-cells and clinical manifestations of the stage of the disease:

This division into stages allows a more thorough approach to the treatment of those infected and regulates the prescription of antiretroviral therapy. In turn, this prevents the development of virus resistance and increases the effectiveness of the drugs used.

How many cells in HIV infection can be affected by the virus?

Immunodeficiency can affect a huge number of structures of any tissue of the body, which leads to a variety of clinical symptoms that are very difficult and almost always impossible to combine into one group and streamline. Therefore, in recent years, all clinical laboratories in AIDS centers have used a unified standard method for determining the stages and requirements for prescribing antiretroviral therapy. All employees of the infection control centers know what changes the human body undergoes at each stage, how it is reflected in the analyzes and how many cells should be. HIV (AIDS) quite naturally affects certain elements at each stage. It is possible to single out the sequential stages of the disease according to the degree and nature of the influence on individual structures:

• The stage of asymptomatic carriage, during which the elements of the lymphatic system suffer the most. This period is characterized by an increase in lymph nodes and mild subfebrile condition, in the first 12 weeks from the moment of infection it is called "acute retroviral syndrome".
• The infection affects the cells of the respiratory system, digestive tract and some areas of the skin, which leads to permanent lung diseases, recurrent stomatitis, mycoses.
• The defeat of the immune system at the third stage makes it possible to destroy structural elements not only by viral particles, but also by opportunistic flora. At the same time, HIV cells actively multiply, using the healthy structures of the patient's body.
• This stage leads to a decrease in the level of immune status to a critically low number of cells. With HIV of the last stage, this figure reaches less than 7 immune units of blood.
• Target cells in AIDS are not only the structures of the immune system, but also the tissues of the nervous system. In most cases, opportunistic flora affects the brain and spinal cord, which leads to painful and painful death.

How many cells in an HIV-infected person should be normal?

With HIV, the rate of SD cells should be more than 350. This level is maintained only with the constant supervision of a specialist who can adequately assess the state of health, prescribe the necessary tests and decipher their results, and also recommend the use of appropriate drugs. At the same time, with a certain frequency, blood tests are taken in specific laboratories to study the qualitative and quantitative composition of immune T cells. With HIV, these structures are among the most vulnerable. Therefore, a systematic study of HIV-affected CD4 cells makes it possible to assess the health status of those infected and prescribe antiretroviral therapy to them in time. This makes it possible to prolong the life of the patient and significantly improve its quality.

How to increase the number of immune cells with HIV?

The protective system of the human body qualitatively and quantitatively depends on the hormonal background. It is influenced by the ratio of vitamins that come with food, a healthy lifestyle, regular physical education, as well as the timely detection, diagnosis and treatment of viral infections. Together, this allows not only to prevent a decrease in immunity, but also to significantly improve this indicator.

There are many examples of HIV-infected people in the world who not only did not allow themselves to be defeated by the disease, but were able to adapt in society and draw public attention to such a complex problem. Due to the careful determination of CD4 cells in the body of patients, many pregnant women received antiretroviral therapy in a timely manner. This allowed them to give birth to healthy children.

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 are 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
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Truvada and Efavirenz.
VN is not defined.

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

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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 the 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 to 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, not analyzes are considered, but a person and his specific life (patients of an infectious disease specialist 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!

The first study is always a leukocyte count (see the chapter "Hematological studies"). Both relative and absolute values ​​of the number of peripheral blood cells are evaluated.

Determination of the main populations (T-cells, B-cells, natural killers) and subpopulations of T-lymphocytes (T-helpers, T-CTLs). For the primary study of the immune status and detection of severe disorders of the immune system WHO recommended determination of CD3, CD4, CD8, CD19, CD16+56, CD4/CD8 ratio. The study allows to determine the relative and absolute number of the main populations of lymphocytes: T-cells - CD3, B-cells - CD19, natural killers (NK) - CD3-CD16++56+, subpopulations of T lymphocytes (T-helpers CD3+ CD4+, T-cytotoxic CD3+ CD8+ and their ratio).

Research method

Immunophenotyping of lymphocytes is carried out using monoclonal antibodies to superficial differential angina on cells of the immune system, using laser flow cytofluorometry on flow cytometers.

The choice of the zone for analysis of lymphocytes is made according to the additional marker CD45, which is present on the surface of all leukocytes.

Conditions for taking and storing samples

Venous blood taken from the cubital vein in the morning, strictly on an empty stomach, into the vacuum system to the mark indicated on the test tube. K2EDTA is used as an anticoagulant. After sampling, the sample tube is slowly inverted 8-10 times to mix the blood with the anticoagulant. Storage and transportation strictly at 18–23°C in an upright position for no more than 24 hours.

Failure to comply with these conditions leads to incorrect results.

Interpretation of results

T-lymphocytes (CD3+ cells). An increased amount indicates hyperactivity of the immune system, observed in acute and chronic lymphocytic leukemia. An increase in the relative index occurs in some viral and bacterial infections at the onset of the disease, exacerbations of chronic diseases.

A decrease in the absolute number of T-lymphocytes indicates a deficiency of cellular immunity, namely, a deficiency of the cellular effector link of immunity. It is detected in inflammations of various etiologies, malignant neoplasms, after trauma, operations, heart attack, smoking, taking cytostatics. An increase in their number in the dynamics of the disease is a clinically favorable sign.

B-lymphocytes (CD19+ cells) The decrease is observed with physiological and congenital hypogammaglobulinemia and agammaglobulinemia, with neoplasms of the immune system, treatment with immunosuppressants, acute viral and chronic bacterial infections, and the condition after removal of the spleen.

NK lymphocytes with CD3-CD16++56+ phenotype Natural killer cells (NK cells) are a population of large granular lymphocytes. They are able to lyse target cells infected with viruses and other intracellular antigens, tumor cells, and other cells of allogeneic and xenogeneic origin.

An increase in the number of NK cells is associated with the activation of anti-transplantation immunity, in some cases it is observed in bronchial asthma, occurs in viral diseases, increases in malignant neoplasms and leukemia, in the period of convalescence.

Helper T-lymphocytes with CD3+CD4+ phenotype An increase in absolute and relative amounts is observed in autoimmune diseases, it may be with allergic reactions, some infectious diseases. This increase indicates the stimulation of the immune system to the antigen and serves as confirmation of hyperreactive syndromes.

A decrease in the absolute and relative number of T cells indicates a hyporeactive syndrome with a violation of the regulatory link of immunity, is a pathognomic sign for HIV infection; occurs in chronic diseases (bronchitis, pneumonia, etc.), solid tumors.

T-cytotoxic lymphocytes with CD3+ CD8+ phenotype An increase is detected in almost all chronic infections, viral, bacterial, protozoal infections. It is characteristic of HIV infection. The decrease is observed in viral hepatitis, herpes, autoimmune diseases.

CD4+/CD8+ ratio The study of the ratio of CD4+/CD8+ (CD3, CD4, CD8, CD4/CD8) is recommended only for monitoring HIV infection and controlling the effectiveness of ARV therapy. Allows you to determine the absolute and relative number of T-lymphocytes, T-helper subpopulations, CTL and their ratio.

The range of values ​​is 1.2–2.6. The decrease is observed in congenital immunodeficiencies (DiGeorge, Nezelof, Wiskott-Aldrich syndrome), viral and bacterial infections, chronic processes, exposure to radiation and toxic chemicals, multiple myeloma, stress, decreases with age, endocrine diseases, solid tumors. It is a pathognomic sign for HIV infection (less than 0.7).

An increase in the value of more than 3 - in autoimmune diseases, acute T-lymphoblastic leukemia, thymoma, chronic T-leukemia.

The change in the ratio may be related to the number of helpers and CTLs in a given patient. For example, a decrease in the number of CD4+ T cells in acute pneumonia at the onset of the disease leads to a decrease in the index, while CTLs may not change.

For additional research and detection of changes in the immune system in pathologies requiring an assessment of the presence of an acute or chronic inflammatory process and the degree of its activity, it is recommended to include counting the number of activated T-lymphocytes with the CD3+HLA-DR+ phenotype and TNK cells with the CD3+CD16++56+ phenotype.

T-activated lymphocytes with CD3+HLA-DR+ phenotype A marker of late activation, an indicator of immune hyperreactivity. By the expression of this marker, one can judge the severity and strength of the immune response. Appears on T-lymphocytes after the 3rd day of acute illness. With a favorable course of the disease, it decreases to normal. An increase in expression on T-lymphocytes can be associated with many diseases associated with chronic inflammation. Its increase was noted in patients with hepatitis C, pneumonia, HIV infection, solid tumors, autoimmune diseases.

ТNK lymphocytes with CD3+CD16++CD56+ phenotype T-lymphocytes bearing CD16++ CD 56+ markers on their surface. These cells have properties of both T and NK cells. The study is recommended as an additional marker for acute and chronic diseases.

Their decrease in peripheral blood can be observed in various organ-specific diseases and systemic autoimmune processes. An increase was noted in inflammatory diseases of various etiologies, tumor processes.

Study of early and late markers of T-lymphocyte activation (CD3+CD25+, CD3-CD56+, CD95, CD8+CD38+) additionally prescribed to assess changes in IS in acute and chronic diseases, for diagnosis, prognosis, monitoring of the course of the disease and ongoing therapy.

T-activated lymphocytes with CD3+CD25+ phenotype, IL2 receptor CD25+ is an early activation marker. The functional state of T-lymphocytes (CD3+) is evidenced by the number of expressing receptors for IL2 (CD25+). In hyperactive syndromes, the number of these cells increases (acute and chronic lymphocytic leukemia, thymoma, transplant rejection), in addition, their increase may indicate an early stage of the inflammatory process. In peripheral blood, they can be detected in the first three days of illness. A decrease in the number of these cells can be observed in congenital immunodeficiencies, autoimmune processes, HIV infection, fungal and bacterial infections, ionizing radiation, aging, heavy metal poisoning.

T-cytotoxic lymphocytes with CD8+CD38+ phenotype The presence of CD38+ on CTL lymphocytes was noted in patients with various diseases. Informative indicator for HIV infection, burn disease. An increase in the number of CTLs with the CD8+CD38+ phenotype is observed in chronic inflammatory processes, oncological and some endocrine diseases. During therapy, the rate decreases.

Subpopulation of natural killers with CD3-CD56+ phenotype The CD56 molecule is an adhesive molecule widely distributed in nervous tissue. In addition to natural killers, it is expressed on many types of cells, including T-lymphocytes.

An increase in this indicator indicates the expansion of the activity of a specific clone of killer cells, which have a lower cytolytic activity than NK cells with the CD3-CD16+ phenotype. The number of this population increases with hematological tumors (NK-cell or T-cell lymphoma, plasma cell myeloma, aplastic large cell lymphoma), chronic diseases, and some viral infections.

A decrease is noted in primary immunodeficiencies, viral infections, systemic chronic diseases, stress, treatment with cytostatics and corticosteroids.

CD95+ receptor is one of the receptors for apoptosis. Apoptosis is a complex biological process necessary for the removal of damaged, old and infected cells from the body. The CD95 receptor is expressed on all cells of the immune system. It plays an important role in the control of the functioning of the immune system, as it is one of the receptors for apoptosis. Its expression on cells determines the readiness of cells for apoptosis.

A decrease in the proportion of CD95+-lymphocytes in the blood of patients indicates a violation of the effectiveness of the last stage of culling of defective and infected own cells, which can lead to a relapse of the disease, chronicity of the pathological process, the development of autoimmune diseases and an increase in the likelihood of tumor transformation (for example, cervical cancer with papillomatous infection ). Determination of CD95 expression has prognostic value in myelo- and lymphoproliferative diseases.

An increase in the intensity of apoptosis is observed in viral diseases, septic conditions, and the use of narcotic drugs.

Activated lymphocytes CD3+CDHLA-DR+, CD8+CD38+, CD3+CD25+, CD95. The test reflects the functional state of T-lymphocytes and is recommended for monitoring the course of the disease and monitoring immunotherapy for inflammatory diseases of various etiologies.