The number of immune cells in HIV. Immune status. CD4 cell count during HIV treatment

Regular monitoring (checking) of CD4 cell count and viral load is a good indicator of how HIV is affecting the human body. Doctors 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. Your viral load can predict how quickly your CD4 levels might drop. When these two results are taken together, you can predict how high your risk of developing AIDS will be in the next few years.

The results of CD4 cell count and viral load tests will help you and your doctor decide when to start ARV (Anti-RetroViral) therapy or treatment to prevent the development of opportunistic diseases.

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

CD4 cell count in people without HIV

The normal number of CD-4 cells in an HIV-negative man is from 400 to 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:

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

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

CD-4 cell count in HIV-infected people

After infection, the CD-4 level drops sharply and then settles at 500-600 cells. People whose CD-4 levels initially fall faster and stabilize at a lower level than others are thought to be more likely to develop HIV infection more quickly.

Even when a person does not have obvious symptoms of HIV, millions of his CD-4 cells become infected and die every day, while other millions are produced by the body and rise to protect the body.

It is estimated that without treatment, the CD4 cell count of an HIV-positive person falls by about 45 cells every six months, with greater loss of CD4 cells seen in people with higher CD4 counts. When the CD4 cell count reaches 200-500, it means that the person's immune system has suffered some damage. A sharp drop in the CD4 count occurs 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 stage of AIDS.

For example, if your CD4 cell count is below 200, it is recommended to take antibiotics to prevent infectious pneumonia.

CD4 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 CD4 cell count. If a person's CD4 count is high, they have no symptoms, and they are not on ART, they likely need to have their CD4 cell count checked every few months. But if a person's CD4 count drops sharply, if they are participating in clinical trials of new medications, or taking ART, then they should test their CD4 cell count more often.

CD4 cell count

Sometimes doctors not only look at the nominal CD4 cell count, but also determine what percentage of all white blood cells are CD4 cells. This is called a CD4 cell percentage test. 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 developing a disease associated with the stage of AIDS.

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 cell count drops to 350, the doctor should help the person determine whether he or she needs to start ART. Doctors recommend that a person start ARV therapy when the CD4 count drops to 250-200 cells. This level of CD4 cells means that a person is in real danger of developing AIDS, an associated disease. It is also believed that if you start ARV therapy when the CD4 count has dropped below 200, then the person will respond less well to treatment. But at the same time, it is known that there is no benefit from starting therapy when the CD-4 cell count is above 350.

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

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bobcat2
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Truvada and Efavirenz.
VN is not determined.

bobcat2
Russia, St. Petersburg Added: 01/20/2011 21:31
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In fact, this topic has been discussed many times already. A brief summary 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've been in therapy for a year and a half now.
Truvada and Efavirenz.
SD as it was 110 cells. it's worth it.
VN is not determined.
I'm not going to change the scheme for now. After all, virological success is obvious.
And the SD, although low, is stable.

There is only one recommendation in this regard: a revision of the ARV regimen with the replacement of NNRTIs with a protease inhibitor boosted by ritonavir. However, the effect is difficult to reproduce - for some it gives an impetus to an increase in the absolute number of CD4 lymphocytes, for others it does not.
What to do for those who have extremely low values without a tendency to increase on a ritonavir-boosted protease inhibitor?

1) Adding Fusion to the scheme. Inapplicable due to unavailability

2) Option 4 drug, e.g. Prezista/ritonavir + isentress + 2 NRTIs

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

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

How to boost immunity for HIV?

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

How does the immune system work?

Knowing how our body’s defense mechanisms work is very important when identifying HIV and, even more so, when diagnosing an infection such as AIDS.

The HIV immune system 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 led by white blood cells or leukocytes, which are capable of destroying all kinds of accumulations of viruses and bacteria that attack our body. These white blood cells and their indicator in blood tests are very important for recognizing all kinds of disorders in the immune system. Normally, in healthy people, their level increases with the development of any infection.

Also an important indicator of the functioning of the human body’s immune system is the presence of cells such as T- and B-lymphocytes. They help produce special antibodies to resist the development of the disease.

And the most important role in the maintenance and functioning of the immune system is played by CD4 cells. 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 HIV infection is established.

What can help boost immunity for HIV?

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

We will look at how to boost immunity against HIV below. Here are the basic rules:

Maintain a healthy lifestyle at all times. This aspect includes several points - giving up smoking, alcohol, regular exercise, spending a long time in the fresh air, hardening.
It is equally important to eat properly and rationally. The point of a healthy diet is to stimulate the immune system by consuming healthy foods rich in vitamins. It is advisable to do this every day as well. 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 or additives) and varied.
Research confirms that excessive stress and people’s experiences do not at all help strengthen the immune system, do not increase the number of protective cells in the body, but on the contrary provoke and worsen the course of this disease. Therefore, the important point is to avoid unnecessary worries and worries, and try to deal with emerging problems as calmly as possible.
Sufficient hours of sleep, also help strengthen the immune system during HIV disease, resist this infection, and also stimulate the functioning of cells to protect against bacteria and viruses.

Medicines to boost immunity

Much and often is written about how to properly strengthen the defenses of a sick body. And most people perfectly understand and know all these recommendations. The main point is that in the case of HIV and AIDS, simply following them is not always enough. We really need the right ways to help curb the development of the disease.

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

Interferon inducers. These are drugs that can stimulate in people the synthesis of a special protein called 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 increase the body's immunity against HIV.
Medicines of microbial origin. They are based on the body’s active resistance to HIV and other diseases, by activating the work of its own defense system. They contain small amounts of components of certain bacteria, which encourage the body's immune system to work and protect itself. The most famous and most often prescribed are Likopid, Imudon, Bronchomunal and others.
Herbal preparations. Their effectiveness lies in the fact that, if used regularly, they help strengthen the immune system and activate it to fight 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, destruction of the body. Therefore, any independent prescription of medications may not give the expected effect. All medications against viruses and bacteria, to stimulate the work of blood protective cells, should be used only after consultation with the treating doctor. The danger is that with HIV you can cause irreparable harm to yourself with any medication!

Traditional medicine for the strength of the immune system

Numerous studies have shown that regular consumption of vitamin C every day helps boost immunity. And the importance of this point is that vitamin C alone will not be enough for our disease. It is desirable and even necessary to consume complexes of drugs with large doses of vitamins B, A, E, C and many others, as well as minerals, every day to stimulate cells against numerous viruses.

A large number of different beneficial substances and vitamins can be found in simple folk remedies and recipes. For example, fruit drinks and infusions, compotes and decoctions of cranberries, lingonberries, and lemon.

Many studies in the field of traditional medicine show that herbal infusions and their various preparations help boost immunity and prevent various diseases. The most recommended for this pathology are flax decoction, linden blossom, lemon balm, St. John's wort and many others.

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

To summarize, I would like to note once again that it is important to strengthen the immune system wisely, without fanaticism, coordinating all the points with the treating doctor, so that this brings unambiguous benefits.

How to enlarge cells for 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 (there was a previous post about this).
2. Increase (or at least not lose) the number of CD4 cells.
3. Make sure that despite all this, the person feels good (or at least tolerably). Because if a person feels bad, he will finish treatment sooner or later. I will draw attention to this point, because it might seem that everything is there, there is medicine, there is success, there is nothing to worry about. In fact, medications can damage your health in the long term (for example, slowly kill your kidneys) and cause significant inconvenience every day.

If everything is more or less clear with the viral load (the virus should not be detected 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 from the point of view of CD4 cells. The most streamlined formulation sounds like this: treatment is successful if CD4 cells have grown. But no one can say for sure how much they should grow. At 50? by 100? Become more than 200 (to protect against AIDS-marking diseases) or more than 500 (to get closer to the immune status of HIV-negative people)?
It’s easier to assess failure - if cells begin to fall during treatment, something needs to 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 specific 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 at the level of every clinic and every infectious disease specialist - no, this doesn’t exist yet.

Just like the viral load, the CD4 cell count 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 each month thereafter. Other data show that during the first year of treatment, the number of cells increased by 100.

Doctors are still arguing Is there a limit to how the immune system can recover? If the number of cells increases, will it always be so, or will they reach their maximum at some point? A subtle question, because it is important from the point of view of “is it necessary to change the drug or is this all, the limit, you can calm down.” For now, it is believed that both options are possible:
1. Slow but steady increase in the number of CD4 cells.
2. Reaching a certain level (it is difficult to predict exactly which one) and after that growth stops.

What can you base your forecast on?

1. Unfortunately, statistics show that the lower the level of CD4 cells at which treatment begins, the less likely it is that they will grow to 500. But the good news is that for CD4 cells any decrease in the viral load is already a plus . The less virus in the blood, the more likely they are to stay alive. And the more cells, the lower a person’s risk of developing an infection or tumor. Therefore, even if medications fail to completely suppress the virus, treatment should be continued in order to preserve your immunological army.

2. The patient's age plays a role. As a rule, the younger a person is, the faster and better his immune system recovers. Although they told me about one grandfather who did not know about HIV positivity until he was hospitalized with an AIDS-marking disease. The prognosis was not very good: age over 60, CD4 count less than 150. We started treatment, grandfather responded very well. CD4 increased to 500. Grandfather is now over 70, everything is ok. This example shows well how different our bodies are and how an individual person can be contrary to all statistical data.

3. Presence of other diseases. Liver cirrhosis plays a negative role, and immunological diseases also have a negative effect. Latent infections such as tuberculosis can worsen (or even make themselves felt for the first time) against the backdrop of a revived immune system, which also causes trouble. It seems that according to the tests everything is going well, but the person is getting worse. I've already started coughing.

4. Whether the person was treated before or not. The best immune response is thought to be in those who have never been treated. In those who interrupt treatment, CD4 cells fall and do not rise to the previous maximum level. That is, by interrupting treatment, a person leaves himself less and less chance of a normal immune system.

There are situations when one of the goals of therapy is achieved, but another is not. For example, the level of the virus decreases below the detection level, and the cells do not grow much. Or vice versa, the cells grow well, but the virus still won’t give up. More often, the first situation occurs: thanks to the tablets, the virus is not detected, but CD4 counts do not increase significantly. Even despite new drugs, this situation occurs in almost a quarter of patients. It is not yet clear to doctors 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 of this increases the patient’s risk of discontinuing treatment). In addition, research shows 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 treatment in the form of prevention of AIDS-marker diseases.

One of the main issues in the treatment of HIV infection is When should treatment actually begin? At first glance, everything is very simple. The lower the CD4 count, the sooner death will occur, which means the sooner treatment must be started. In reality, everything is more complicated. The toxicity of the drugs must also be taken into account. Let's just say, you can imagine a year of living with bouts of diarrhea. What about 20 years? Despite the fact 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.
We should not forget about the country’s financial resources. Treating 200 people or treating 1000 people a year - there is a difference. Therefore, in poorer countries, treatment began with 200 CD4 cells, in richer countries (America, for example) - with 500. Most countries are still inclined to believe that 350 CD4 cells is already a solid indication for starting treatment. We are targeting 400. Let me remind you that almost half of our patients begin treatment with 250 cells, although they could have started with 400 if they had come earlier. Based on everything written above, it’s a shame that they are losing these 150 cells in conditions where the state agrees to treat them for free (yes, that’s how it is in Estonia. You register with an infectious disease specialist, come once a month for medications, and receive them against signature in a special office from the hands of a nurse. 5 days a week, from 8 to 4. Such offices are located at hospitals and clinics).

The very last, but perhaps the most important point: Is the person ready to undergo treatment? It turns out that without a clear, conscious desire to be treated, there may be no point in rushing (in a situation where there are, for example, 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, by taking breaks a person gives it a chance for this). Because the side effects that will be endured not by the doctor, but by the person himself, every day. For example, most drugs are not compatible with alcohol. You see, yes, what a problem this is. You have to take the drugs 2 times a day, so it’s difficult to find a moment to take a drink, sober up, and then take a pill. One man tells us: “When I drink, I don’t take pills, it’ll make me feel bad. How often do I drink? Well, 2 times a month. How many days? well, 10 days.”
Some tablets need to be taken only at night, which is not suitable for those who work at night or on shifts. The first month or two will be especially unpleasant, the body will get used to it, the immune system will take wings, hidden infections will awaken - 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 hepatitis C is present, how the kidneys work, etc.

In general, the start of treatment, the choice of drugs, the treatment itself is a purely individual matter. In each specific case, it is not the tests that are considered, but the person and his specific life (infectious disease patients have more than special lives). Therefore, the more time you have to make a decision and talk with the doctor, the better. And this all depends on the person’s immune status and his knowledge of whether he has HIV or not. So, as usual, I’ll end with the fact that we need to test and test, then there will be time to think.

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What if therapy does not increase immunity?

Hello! We are writing to you because we despair of finding at least some understanding at the AIDS center. The fact is that my husband has HIV and hepatitis C for more than 10 years. He has been going to the center for ten years, receiving therapy, but there are no significant improvements ((That is, at first (about a year later) the immune cells grew to about 250 and the viral load disappeared. But then the progress stopped, the cells do not grow any further. I took different therapies, we don’t remember all of them. But improvement began only 1.5 years ago, with the new therapy atazanavir + lamivudine + abacavir. Cells grew to 400. But this therapy was canceled, citing the fact that everything was fine and you could take other drugs . They changed to atazanavir + combivir, 7 months ago. Since then everything has gotten worse ((and in the last test they found a viral load of 1000 ((The doctor told her husband that he probably wasn’t taking pills, she had no other explanation (and ordered 26 September. My husband is depressed, I’m very worried. But at the center it’s useless to ask, they don’t want to talk ((Questions:
1. Why don’t cells improve for so many years?
2. Why did they change the scheme that was helping?
3. Should doctors at the center provide consultations 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 correct to take medications for dysbacteriosis? No tests, but symptoms((
Please answer, we are very worried!

Probably absolutely any HIV-positive person knows what CD4 is. Well, or at least heard about it.

For those who are encountering this concept for the first time, we will try to tell you in as much detail as possible about what it is. Why do we need CD4 in our body? And why, the fewer there are, the more different diseases there are in the body.

Perhaps we should start with the fact that CD4 cells are one of the types of T-lymphocytes - the most important cells of the immune system of the human body. There are 3 types of lymphocytes - B-, T- NK-lymphocytes. Each of the varieties carries special functions and, when the level of at least one type of lymphocytes decreases, the human body becomes vulnerable to pathogens of various diseases. B-lymphocytes are “spies” of our body; they carry information about the causative agents of various diseases. Having “scanned” an alien agent at least once, they remember it forever. It is because of these “spies” that a person develops immunity to those diseases that he has already had, or to diseases for which he has been vaccinated. As a rule, B-lymphocytes in the body make up about 10-15% of the total number of lymphocytes. Another type of lymphocytes are NK lymphocytes - the “KGB agents” of the body. They make sure that there are no “traitors” in the body, i.e. infected body cells or tumor cells. If such “traitors” are detected, NK lymphocytes destroy them. There are 5 - 10% of them in the body. Well, the most numerous group of lymphocytes are T-lymphocytes. These are the “soldiers” of the immune system, they make up about 80% of the total number of lymphocytes. They are precisely engaged in the detection and destruction of bacteria, fungi, and viruses foreign to our body.

Since T-lymphocytes are the largest group of lymphocytes, and the main function they perform is the direct protection of the body, it is absolutely logical that they also share the main areas of protection among themselves. There are 3 groups of T lymphocytes: killer T cells, helper T cells and suppressor T cells. Killer T cells are cells of the immune system that are involved in the direct destruction of enemy agents that enter the human body. It is these cells that kill viruses, bacteria, bacteriophages and other foreign microorganisms. CD8 coreceptors are located on the surface membrane of this type of T lymphocyte. T-helpers, as the name implies, are helpers. They enhance the immune response and also act as a transmitter of information about a foreign agent to B lymphocytes, which, in turn, produce the necessary antibodies. The coreceptor of T-helper cells is CD4, a monomeric transmembrane glycoprotein. The presence of this type of coreceptor serves as a distinctive feature of T-helper cells. Therefore, when talking about CD4, we most often mean T-lymphocytes of the helper type. The next type of T-lymphocytes are T-suppressor cells. These are lymphocytes that are responsible for restraining the immune system, creating conditions so that the immune response is of comparable strength, not too strong.

Why is it that knowledge about CD4 is most important in the context of talking about HIV? First of all, because these cells are the targets of the human immunodeficiency virus. HIV invades these cells and replaces the cell's genetic information with its own. It turns out that the CD4 cell dies and gives a signal to produce more lymphocytes. And the virus that has multiplied in the dead cell is already ready to penetrate the newly formed T-helper cells. And it turns out to be a vicious circle that the immune system cannot cope with. Thus, it turns out that at the beginning of the disease, the number of CD4 in the body of HIV-positive people even increases, and people with HIV-positive status note that they practically do not get colds. But over time, the immune system wears out, and the number of lymphocytes begins to decrease significantly. In the normal state of the body, CD4 cells should be about 500 - 1600 cells. With HIV, the CD4 count begins to decrease significantly and may even reach 0.

The fewer lymphocytes, the higher the likelihood of developing certain diseases. Antiretroviral therapy can increase lymphocyte levels and reduce viral load.

There are two very important tests that all people with HIV need - immune status and viral load. Sometimes their meanings can be difficult to understand. At the same time, it is thanks to them that it is possible to determine the moment to start treatment and the effectiveness of the drugs. This article describes basic information about these tests that cannot replace a conversation with your doctor, but can help facilitate the dialogue between the doctor and the patient.
What is immune status?
Immune status determines the number of different cells of the immune system. For people with HIV, what matters is the number of CD4 cells or T-lymphocytes - white blood cells that are responsible for “recognizing” various pathogenic bacteria, viruses and fungi that must be destroyed by the immune system.
CD4 cell count is measured as the number of CD4 cells per milliliter of blood (not the whole body). It is usually written as cells/ml. The CD4 cell count of an HIV-negative adult is usually somewhere between 500 and 1200 cells/mL. HIV can infect CD4s and make copies of itself in them, causing the cells to die. Although cells are killed by HIV every day, millions of CD4 cells are produced to replace them. However, over a long period of time, the CD4 count can decrease and even drop to dangerous levels.
What does the CD4 count tell you?
For most people with HIV, their CD4 count usually declines over a period of years. A CD4 count between 200 and 500 indicates a weakened immune system. If your CD4 count falls below 350 or begins to decline rapidly, this is a reason to talk to your doctor about prescribing antiretroviral therapy.
If the CD4 cell count is 200-250 cells/ml or lower, initiation of therapy is recommended, since with such an immune status there is a risk of AIDS-associated diseases. The main thing that the CD4 count tells us is the health of the immune system, whether it is worsening or improving.
Changes in CD4 count
Your CD4 cell count can rise and fall as a result of infections, stress, smoking, exercise, your menstrual cycle, birth control pills, the time of day, and even the time of year. Moreover, different test systems may give different CD4 count results.
That is why it is very important to regularly get tested for your immune status and look at changes in the results. It is impossible to assess the health status of an HIV-positive person with one single test. It is also best to measure your CD4 count in the same clinic, around the same time of day. If you have an infection, such as a cold or herpes, it is best to delay getting tested until your symptoms have gone away.
If you have a relatively high CD4 cell count, no symptoms, and are not taking antiretroviral therapy, getting your immune status tested every 3 to 6 months is sufficient. However, if your immune status is rapidly declining or you start taking medications, your doctor should suggest you get tested more often.
If your CD4 cell count varies greatly from time to time, your total white blood cell count may be changing, possibly due to an infection. In this case, the doctor will pay attention to other indicators of immune status. For example, the CD4/CD8 ratio.
CD8 are other cells of the immune system that are not affected by HIV. On the contrary, with the development of HIV infection, their number does not decrease, but increases, as the body’s reaction to the infection. Normally, the numbers of CD4 and CD8 are approximately equal, but as the disease progresses, the CD4/CD8 ratio decreases. However, if a person has a normal CD4 cell count, the CD8 count does not matter much.
The CD4 percentage also indicates the true state of the immune system.
CD4 percentage
Instead of counting the number of CD4 per milliliter, your doctor can estimate the percentage that CD4 make up of the total number of white cells. This is the percentage of CD4 cells. Normally it is about 40%. A CD4 percentage of less than 20% is about the same as a CD4 count of less than 200 cells/mL.
A viral load test determines the number of virus particles in a fluid, more precisely in blood plasma. This test only detects HIV genes, that is, the RNA of the virus. The viral load result is measured in the number of copies of HIV RNA per milliliter. Viral load is a "predictive" test. It shows how quickly a person's immune status can decrease in the near future.
If we compare the development of HIV infection with a train that goes to its destination (AIDS-associated diseases), then the immune status is the distance that remains, and the viral load is the speed at which the train is moving.
Currently, different types of viral load tests are used. Each test system is a different technique for detecting viral particles, so it will depend on the test system whether the result is considered low, medium or high. Nowadays, viral load tests are reliable for any subtype of the virus.
Natural variations
Viral load levels may rise or fall, but this does not affect a person's health. Research shows that for people not taking antiretroviral therapy, two viral load tests from the same blood sample can differ by up to three times. In other words, you don't necessarily need to worry if your viral load rises from 5,000 to 15,000 copies/ml if you don't take treatment. Even a twofold increase may turn out to be a simple error in the test system.
Ideally, you should test your viral load when you are healthy. If you have had an infection or have recently been vaccinated, your viral load may temporarily increase.
Significant changes
There is cause for concern only when the viral load test result remains elevated for several months, or if the viral load has more than tripled. For example, if the viral load increased from 5,000 to 25,000 copies/ml, this is a significant change, since the result has increased fivefold. However, it is still best to re-test to confirm the trend of increasing viral load.
Effect of vaccinations and infections
If you have recently had an infection or been vaccinated, you may experience a temporary increase in your viral load. In these cases, it is recommended to postpone the viral load test for at least a month after vaccination or illness.
Minimizing deviations
Information about changes in viral load will be more reliable if the tests are done in the same clinic using the same method. If this is your first time taking a viral load test, try to remember the method that was used for it. When you take a viral load test in the future (especially if you take it at another hospital), make sure that the same method that was used to determine your load will be used.
If you are not taking antiretroviral therapy
If you are not taking antiretroviral therapy, your viral load can predict whether you will develop HIV infection without taking therapy.
Findings from a study examining changes in viral load in people not taking antiretroviral therapy suggest that, when combined with CD4 cell count, viral load may predict the risk of developing symptoms in the future. In people with the same CD4 cell count, the researchers found that those with higher viral loads tended to develop symptoms more quickly than those with low viral loads. Among a group of people with the same viral load, symptoms developed more often in those who had lower immune status.
Taken together, CD4 cell count and viral load provide a basis for predicting the development of HIV infection in the short and medium term.
The decision to start antiretroviral therapy
Your viral load level, along with other indicators, can help you decide whether to start treatment or not.
There are currently guidelines to guide clinicians when deciding when to initiate antiretroviral therapy, with CD4 cell count playing a larger role than viral load. It is recommended to start therapy before the immune status drops to 200 cells. In people with higher immune status, the decision to prescribe therapy may depend on the level of viral load, the rate of decline in immune status, the likelihood of strict adherence to therapy, the presence of symptoms, and the wishes of the patients themselves.
People who have been advised to start antiretroviral therapy but decide to defer it should monitor their immune status and viral load more regularly and consider taking it again.
If we compare the same indicators of immune status in women and men, then in women, on average, the immune status begins to decline with a lower viral load. However, this does not in any way affect the body's response to antiretroviral therapy.
What does an undetectable viral load mean?
All tests that measure viral load have a sensitivity threshold below which they cannot detect HIV. It may be different in different test systems. However, the fact that the viral load is not detectable does not mean that the virus has completely disappeared from the body. The virus is still present in the body, but in such small quantities that the test has difficulty detecting it. Viral load tests only measure the amount of virus in the blood. Even if you have an undetectable viral load, this does not mean that it is also undetectable in other parts of the body, such as in semen.
What is the detection threshold for current tests?
Test systems used in most hospitals in Russia determine the amount of virus up to 400-500 copies/ml. Some modern hospitals use more sensitive tests that detect up to 50 copies/ml. A test system has already been developed that determines the level of the virus in the blood up to 2 copies/ml, but it is not yet used anywhere.
What are the benefits of having an undetectable viral load?
It is desirable to have an undetectable viral load for two reasons:
- very low risk of progression of HIV infection
- very low risk of developing resistance to antiretroviral drugs taken.
It is precisely in reducing the viral load to an undetectable level that the purpose of antiretroviral therapy lies, according to doctors. For some people, it may take 3 to 6 months for the viral load to decrease to an undetectable level, for some it takes 4-12 weeks, and for others the load may not decrease to an undetectable level. People taking antiretroviral therapy for the first time are more likely to have their viral load reduced to undetectable levels than those who have already taken it. Doctors usually recommend changing the combination of drugs or changing one of the drugs if the viral load does not decrease to undetectable levels after 3 months of treatment.
However, doctors have different opinions about how quickly medications should be changed. Some believe that the sooner you change drugs, the lower the risk of developing resistance. Others feel that this may cause them to stop taking therapies that are effective for them. When changing your therapy regimen, you should be prescribed drugs that you have not taken before and that do not belong to the same class. The more drugs you change, the more problems with resistance may arise.
The faster your viral load drops to undetectable levels, the longer it will remain undetectable if you strictly adhere to your medication regimen. After 6 months of therapy without changing medications, ideally the viral load should decrease to an undetectable level. But this is not a mandatory condition, although desirable. It's important to remember that even if your viral load has dropped to 5,000 copies, your risk of developing AIDS-related illnesses is very low if your viral load remains at that level.
If you have a high viral load in your blood, you may also have a high viral load in your semen or vaginal secretions. The higher the viral load, the higher the risk of HIV transmission may be. Antiretroviral therapy that reduces the viral load in the blood usually also reduces the level of virus in semen and vaginal secretions. However, if your viral load in your blood drops to an undetectable level after taking therapy, this does not mean there is no longer the virus in your semen or vaginal secretions. However, the risk of HIV transmission during unprotected sex exists, although it decreases with a low viral load. If you have other untreated sexually transmitted infections, especially gonorrhea, they can increase the viral load of semen and vaginal secretions, thereby increasing the risk of HIV transmission through unprotected contact.
Antiretroviral therapy has been shown to be effective in reducing the risk of mother-to-child transmission of the virus. If you are pregnant or planning to become pregnant, be sure to discuss your medication choices with your healthcare provider. If you have an undetectable viral load during pregnancy, the risk of passing HIV to your baby will be very low.
If you are not taking therapy
There is a significant difference in the progression of HIV infection when comparing viral loads below 5000 copies and above 50,000 copies/ml, even if the immune status is above 500 cells.
If the immune status is in the range of 350-200 cells and is rapidly declining, you should see a doctor every month or, if possible, every week, since with a sharp decrease in immune status there is a risk of developing AIDS-related diseases.
If your immune status is above 500 cells, it is advisable to visit your doctor to measure your viral load every 4-6 months.
If your viral load increases while on therapy
It is necessary to repeat the viral load test after 2-4 weeks to confirm the first result. It is advisable to take tests for viral load and immune status always at the same time.
Edited by Misima (02/09/2008 08:16:21 PM)

In the time since the discovery of the human immunodeficiency virus, serious progress has been made in treatment. But until now, those infected and their loved ones are interested in the viral load of HIV, its indicators and the norm. These data are taken into account when selecting therapeutic methods that extend years. In the absence of treatment, doctors predict up to 10 years of life for people with HIV; with properly selected treatment - up to 70. Not the least important place in such a 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 are the ones who can protect the infected person from concomitant diseases leading to mortality or AIDS. A general blood test, also prescribed for HIV, helps to clarify the situation. If the level of antibodies to the virus is low, it is enough to undergo examination twice a year; if increased during pregnancy, taking rotating 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 manifests itself in plasma, although it is found in seminal fluid and vaginal mucus. HIV testing is a multicomponent diagnosis. Blood is taken for various studies:

Blood test for HIV. Often the virus is first detected when taking a blood test for HIV and hepatitis.
A general blood test 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 don’t know how HIV tests are done, on an empty stomach or not, doctors will answer: biological material is collected on an empty stomach. This ensures reliable results.

Rapid tests for HIV. They give results within 30 minutes. They study not only blood, but also saliva and urine. The test is informative in terms of diagnosing infection and the number of antibodies. Sometimes it happens that the test for HIV is positive, but the analysis is negative. The result is false negative if the infection occurred recently. You will need to undergo this examination in 6 weeks.
Enzyme immunoassay. Serum is isolated from the blood, where antibodies to the human immunodeficiency virus are looked for. When patients ask how long it takes to test for HIV, doctors answer: up to 10 days. But even here the possibility of erroneous results remains. This is affected by autoimmune diseases, exacerbations of chronic diseases, and cancer.

When wondering where you can get tested for HIV, you should contact a private laboratory, AIDS and HIV prevention and control centers, 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 for HIV analysis ranges from 300 to 12,000 rubles. Research in private laboratories and highly sensitive tests remain more expensive.

Diagnostics

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

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

A detailed diagnosis is prescribed after a general blood test has been performed, which is advisable to do in case of 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 general blood cell counts.

Diagnostics helps to determine the number of leukocytes. Future treatment and quality of life also depend on the ratio of them and antibodies to the virus. In addition to general methods, specific techniques 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 has a short readiness time - up to 3 days.

Immunoblotting

This is a highly sensitive and not the cheapest method for recognizing a viral infection. It involves separating the viral proteins, after which they are transferred to a nitrocellulose membrane. After the electrophoresis procedure, its antigens, which differ 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 number decreases to 200-500, changing every six months by 45 units, there is a high probability of infection. But the possibility of diseases affecting immune processes, pregnancy and breastfeeding in women is also taken into account.

Also, a blood test for HIV has standards for infected people. If the cell count drops to 350, it’s time to start therapy. Thanks to this, concomitant diseases that are dangerous for infected people will not develop.

If the number has dropped to 200 units, highly active antiretroviral therapy is often prescribed. Those suffering from immunodeficiency are advised to get tested for HIV and hepatitis. Liver diseases often accompany a dangerous virus and aggravate the immune system.

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

Those infected are interested not only 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 violation of test conditions, after vaccinations, or due to previous diseases. This also applies to healthy people. But if after a month the indicator increases by 3-5 times, this is a reason to think about it.

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

What is immune status

The set of quantitative and qualitative indicators of immunity is the immune status. It is better to measure it at the same time of day, in the same laboratory, using the same tests. The difference between 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 - mandatory parameters for diagnosis and possible treatment. The task of doctors is to increase the immune status that fights the virus. However, it is capable of infecting CD-4 cells, their number can sharply decrease to a critical level. That is why the patient is periodically diagnosed.

Results and interpretation of analyzes

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

Scientists identify the following indicators:

Up to 20 thousand copies/ml – insufficient RNA concentration. This is a good result for an infected person. In a healthy person, the indicator should be 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 greater the likelihood of developing AIDS.

Important! You can donate blood again if you have a false negative, false positive or incorrect result. A negative result is true if there is no risk of infection in the 12 weeks before blood collection.

Routes of transmission of viral infection

The cost of an HIV test makes it accessible to everyone. The relevance of the problem is confirmed by common methods of transmission of infection: the use of unsterile medical instruments, in particular syringes, the route from mother to child, during unprotected sexual intercourse, and through blood transfusion.

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

What to do for infected people and their loved ones:

Monitor the number of RNA copies of the HIV virus. This reduces the risk of maternal infection of the fetus and also increases the life expectancy of the infected person.
Get tested in a timely manner and responsibly take courses of antiretroviral therapy.
Remember that not only the determination of the viral load in HIV is an important indicator, but its correlation with the results of 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 ensure that the number of viral particles does not go beyond the normal range. Even with this diagnosis, you can continue to live a full life.

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 discussed previously).
2. Increase (or at least not lose) the number of CD4 cells.
3. Make sure that despite all this, the person feels good (or at least tolerably). Because if a person feels bad, he will finish treatment sooner or later. I will draw attention to this point, because it might seem that everything is there, there is medicine, there is success, there is nothing to worry about. In fact, medications can damage your health in the long term (for example, slowly kill your kidneys) and cause significant inconvenience every day.

What can you base your forecast on?

1. Unfortunately, statistics show that the lower the level of CD4 cells at which treatment begins, the less likely it is that they will grow to 500. But the good news is that for CD4 cells any decrease in the viral load is already plus. The less virus in the blood, the more likely they are to stay alive. And the more cells, the lower a person’s risk of developing an infection or tumor. Therefore, even if medications fail to completely suppress the virus, treatment should be continued in order to preserve your immunological army.

There are situations when one of the goals of therapy is achieved, but another is not. For example, the level of the virus decreases below the detection level, and the cells do not grow much. Or vice versa, the cells grow well, but the virus still won’t give up. More often, the first situation occurs: thanks to the tablets, the virus is not detected, but CD4 counts do not increase significantly. Even despite new drugs, this situation occurs in almost a quarter of patients. It is not yet clear to doctors 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 patient’s risk of discontinuing treatment). In addition, research shows 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 treatment in the form of prevention of AIDS-marker diseases.

One of the main issues in the treatment of HIV infection is When should treatment actually begin? At first glance, everything is very simple. The lower the CD4 count, the sooner death will occur, which means the sooner treatment must be started. In reality, everything is more complicated. The toxicity of the drugs must also be taken into account. Let's just say, you can imagine a year of living with bouts of diarrhea. What about 20 years? Despite the fact 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.
We should not forget about the country’s financial resources. Treating 200 people or treating 1000 people a year - there is a difference. Therefore, in poorer countries, treatment began with 200 CD4 cells, in richer countries (America, for example) - with 500. Most countries are still inclined to believe that 350 CD4 cells is already a solid indication for starting treatment. We are targeting 400. Let me remind you that almost half of our patients begin treatment with 250 cells, although they could have started with 400 if they had come earlier. Based on everything written above, it is a pity that they are losing these 150 cells in conditions when the state agrees to treat them for free (yes, this is the case in Estonia. You register with an infectious disease specialist, come once a month for medications, and receive them against signature at in a special office from the hands of a nurse, 5 days a week, from 8 to 4. Such offices are located at hospitals and clinics).

The very last, but perhaps the most important point: Is the person ready to undergo treatment? It turns out that without a clear, conscious desire to be treated, there may be no point in rushing (in a situation where there are, for example, 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, by taking breaks a person gives it a chance for this). Because the side effects that will be endured not by the doctor, but by the person himself, every day. For example, most drugs are not compatible with alcohol. You see, yes, what a problem this is. You have to take the drugs 2 times a day, so it’s difficult to find a moment to take a drink, sober up, and then take a pill. One man tells us: “When I drink, I don’t take pills, I’ll feel bad. How often do I drink? Well, 2 times a month. How many days? Well, 10 days.”
Some tablets need to be taken only at night, which is not suitable for those who work at night or on shifts. The first month or two will be especially unpleasant, the body will get used to it, the immune system will take wings, hidden infections will awaken - 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 hepatitis C is present, how the kidneys work, etc.