Persistent Immune Activation And Inflammation
HIV infection results in heightened systemic immune activation and inflammation, which predict more rapid CD4 cell decline and progression to AIDS and death, independent of plasma HIV RNA levels.28 Although immune activation declines with suppressive ART, it often persists at abnormal levels in many individuals with HIV maintaining long-term ART-mediated viral suppressioneven in those with CD4 cell recovery to normal levels.29, 30 Immune activation and inflammatory markers also predict mortality and non-AIDS morbidity during ART-mediated viral suppression, including cardiovascular and thromboembolic events, cancer, neurocognitive dysfunction, and frailty.28 A low CD4/CD8 ratio also might reflect this inflammatory state to some degree,31 although it predicts AIDS events far more strongly than non-AIDS morbidity.32 Although individuals with poor CD4 cell recovery tend to have greater immune activation and inflammation than those with greater recovery,29 the relationship between innate immune activation and inflammation and morbidity/mortality is largely independent of CD4 cell count.33, 34 Even in individuals with CD4 counts > 500 cells/mm3, immune activation and inflammation are associated with increased morbidity and mortality.35, 36
ART as a Strategy to Reduce Inflammation
Other Immune-Based Strategies
Treatments Targeting Traditional Risk Factors and Inflammation
Treatments Targeting Putative Drivers of the Inflammatory State
Cd4 Count And Hiv Treatment
Several different organizations and institutions make recommendations about when to start HIV treatment. The US Department of Health and Human Services , WHO , EACS , BHIVA , and the IAS-USA all recommend that HIV treatment be offered to all people living with HIV, regardless of their CD4 count. Research shows that people living with HIV who start treatment right after diagnosis, while their CD4 counts are still high, have a much lower risk of developing other illnesses or dying.
The DHHS treatment guidelines state:
- HIV treatment is recommended for anyone who is living with HIV, no matter their CD4 count
- HIV treatment is also strongly recommended if you are in one or more of the following situations, no matter your CD4 count:
- You have or had symptoms of AIDS
- You need treatment for hepatitis B and/or hepatitis C
Cd4 Count As An Indicator Of Disability
Unfortunately, reproducible, standardized, and widely accepted measures of HIV functional impairment are limited. However, a strong relationship exists between advanced immune impairment and clinical outcomes, including mortality, although exceptions can occur. Laboratory markers of HIV infection are important indicators of the severity of disease. In the absence of direct measures of disability, the committee reviewed a variety of measures, notably CD4 count and viral load, to evaluate their efficacy in predicting morbidity, mortality, and treatment response. The committee concluded that viral load is a strong indicator of success of antiretroviral therapy, while CD4 is a strong indicator of disease progression. Therefore, CD4 is more appropriate in assessing disability than viral load.
Based on this review, the CD4 count was found to meet many of the principles identified in for a listing and is already fully incorporated in current medical practice. Of the predictive measures considered, CD4 count is part of a routine standard of care for patients with HIV/AIDS, commonly used, and an objective measure found easily in the medical record. All patients being medically managed for HIV infection should have serial CD4 count determinations in their medical records.
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What Is A Healthy Cd4 Count
Its normal for your CD4 count to be checked by your health care provider every three months. The higher the CD4 count, the healthier the immune system – this is why a higher CD4 cell count is indicative of a better functioning immune system.
While the CD4 count for those without HIV typically ranges between 500-1500, people living with HIV may have :
- CD4 count of over 500: This means that treatment is effective and the person is in good enough health
- CD4 count below 200: This means the person is at high risk of developing a serious illness, this includes AIDS
Its important to keep in mind that many people might not experience any signs or symptoms of HIV and early detection is key to beginning treatment and going on to live a healthy life – this is why its so important to regularly screen your sexual health.
Testing for HIV can be done with your local doctor or from home with an at-home lab test. LetsGetCheckeds at-home STI Tests detect some of the most common sexually transmitted infections. The test for HIV involves a simple finger-prick sample and online results will be available within 2-5 days. Our dedicated medical team will be available throughout the process to provide support and guidance in any way they can.
You consider taking a test if:
What The Results Mean
A normal CD4 count is from 500 to 1,400 cells per cubic millimeter of blood. CD4 counts go down over time if you do not take ART.
At levels below 200 cells per cubic millimeter, you are more likely to get to a wide variety of OIs, many of which can be deadly.
Your CD4 levels behave differently depending on your stage of HIV:
Stage 1: Acute HIV Infection. HIV is reproducing in large amounts and destroying CD4 cells. Thatâs why CD4 levels typically fall quickly at first. Then, as your immune system responds, your viral load begins to fall and your CD4 levels start to rise again. But they might not return to pre-infection levels.
Stage 2: Chronic HIV Infection. HIV is still active but reproduces much more slowly. ART treatment can keep you in this stage for many decades. This can help maintain CD4 at healthy levels, sometimes indefinitely. If this period starts to head toward stage 3, your viral load goes up and CD4 levels go down.
Stage 3: AIDS. Your immune system is damaged badly enough to allow opportunistic infections of different types. Your doctor might diagnose AIDS because of these. But your doctor can also diagnose this stage by CD4 levels. Once they get below 200, most doctors will diagnose AIDS.
Anyone who is HIV-positive should take antiretroviral therapy medications regardless of their CD4 count and whether or not they have symptoms. When your treatment is working, your CD4 count should stay steady or go up.
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Cd4 Count Vs Viral Load
Theres no direct relationship between CD4 count and viral load.
In the past, doctors used the CD4 count as an indicator of when to start therapy, but advances in HIV medication have changed this. Now it serves as an indicator of immune system stability.
However, in general, a high CD4 count and a low or undetectable viral load are desirable. The higher the CD4 count, the healthier the immune system. The lower the viral load, the likelier it is that HIV therapy is working.
When HIV invades healthy CD4 cells, the virus uses them to make new copies of HIV before destroying them. When HIV remains untreated, the CD4 count decreases, and the viral load increases.
The following chart gives a general idea of what the levels of CD4 and viral load mean for a person with HIV, based on guidelines from the U.S. Department of Health and Human Services.
|How serious is this?|
|After levels remain stable for 2 years.||Up to 6 months interval|
What Can You Do To Look After Yourself
The most important thing is to start HIV treatment, and to take it exactly the way you are advised to .
Attend your HIV clinic for regular check-ups. These monitor how your treatment is working, with regular screening for other health problems. Having a good relationship with your healthcare team is important, so that you feel able to be honest about your health, lifestyle, adherence and any other issues, to help you receive the best possible care and support.
“Once your CD4 count improves, with continued treatment and care, your life expectancy is very good.”
Register with a GP for non-HIV-related health problems. GPs can give you an annual flu vaccination , and provide advice on lifestyle factors that help keep you well, including healthy eating, exercise and giving up smoking.
While your CD4 count is low , ensure your drinking water is free from infection and take extra care in preparing and storing food to avoid food poisoning. Be careful to avoid infections if you are handling animals or gardening. Your healthcare team can talk to you about any risks and give you advice.
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What Is Cd4 & Why Is It Important
Human immunodeficiency virus targets the immune system and in its most advanced stage of infection manifests as acquired immunodeficiency syndrome . This can take from 2 to 15 years to develop depending on the individual. 1
The virus destroys and impairs the function of immune cells so that infected people gradually become immune-deficient and therefore susceptible to certain types of cancer and opportunistic infections . People with healthy immune systems can more easily fight off these types of infection.
All cells in the human body express certain proteins and other molecules either on the cell surface or inside the actual cell. To make it easier to identify the cells, the scientific community has given each molecule a specific number. CD4 is a protein on the surface of T helper cells, a subset of T cells and play an important part in the bodys immune system. These white blood cells circulate throughout the body to find and destroy bacteria, invading organisms – and viruses.
If you want to know the health of persons immune system, you measure the number of CD4 cells they have in their blood. Following diagnosis, a patient should obtain a CD4 count for a baseline measurement. This provides a benchmark to compare with future tests results.
What Do The Results Mean
CD4 results are usually given as a number of cells per cubic millimeter of blood. But labs may have different ways of describing “normal” CD4 counts. What’s normal for you depends on your age, other health conditions, and the medicines you may take. That’s why it’s important to talk with your provider about what your test results mean.
CD4 counts may change even when your health has not changed. So, your provider will usually look at a few test results over time to see if there’s a trend in your CD4 counts.
In general, ranges for CD4 counts are:
- Normal CD4 count for healthy adults and teens: 500 to 1,200 cells per cubic millimeter
- Low CD4 count: Below 500 cells per cubic millimeter
- If you have HIV, a low CD4 count means that HIV has weakened your immune system. A CD4 count of 200 or fewer cells per cubic millimeter means that you have AIDS. With AIDS you have a high risk of developing life-threatening infections or cancers.
- If you don’t have HIV, a low CD4 count may be caused by an infection. Cancer chemotherapy and medicines that weaken your immune system may also cause low CD4 counts. In certain cases, the cause of a low CD4 count is unknown, but this is uncommon.
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Why Is Hiv Therapy So Important
HIV therapy is also called antiretroviral therapy or highly active antiretroviral therapy . It consists of a combination of antiretroviral drugs. Theyre designed to keep the virus from spreading throughout your body by targeting different proteins or mechanisms the virus uses to replicate.
Antiretroviral therapy can make the viral load so low that it cant be detected by a test. This is called an undetectable viral load . If a person is virally suppressed or has an undetectable viral load, their HIV is well managed.
Starting HIV therapy as soon as an HIV diagnosis is received helps allow a person to live a long, healthy life.
Current treatment guidelines provided by the U.S. Department of Health and Human Services recommend that a person living with HIV begin antiretroviral drugs as soon as possible after diagnosis. This is essential to reducing opportunistic infections and preventing complications from HIV.
Effective treatment can also help prevent the transmission of HIV to others. This is also known as treatment as prevention.
According to the
What Treatment Would Be Given For A Low Cd4 Count
A low CD4 count can be improved by treating the underlying problem. Anyone with HIV, including those with a low CD4 count, is treated with antiretroviral therapy, or ART.
Antiretroviral therapy involves a combination of different medicines, called antiretrovirals, or ARVs. By preventing the virus from replicating, these drugs reduce the HIV levels in the body . As the viral load decreases, more CD4 cells can survive.
There are seven types or classes of HIV medicines that work in slightly different ways:
- Nucleoside reverse transcriptase inhibitors
- Non-nucleoside reverse transcriptase inhibitors
- Integrase strand transfer inhibitors
- Protease inhibitors
- Fusion inhibitors
- Post-attachment inhibitors
An antiretroviral therapy regimen often includes three drugs, and at least one of the drugs is usually from a different class than the others. Combining drugs with varying mechanisms increases the efficacy of the treatment and prevents the virus from developing a resistance to the medicines.
HIV treatment is lifelong, and the key to treatment success is consistency. Starting antiretroviral therapy as early as possible, taking the medications daily, and visiting a doctor regularly helps ensure that the virus is kept at bay. CD4 cell counts can only improve if the viral load is suppressed.
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Flu Symptoms And Treatment
If you get sick with flu symptoms call your doctor right away. There are antiviral drugs that can treat flu illness and may prevent serious flu complications. These drugs work best the sooner they are started. CDC recommends prompt treatment for people who have flu infection or suspected flu infection and who are at higher risk of serious flu complications, such as people living with HIV.
Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people also may have vomiting and diarrhea, though this is more common in children than in adults People may be infected with flu and have respiratory symptoms without a fever.
What Is A Cd4 Count
A CD4 count is a blood test to check the amount of CD4 cells in the body. CD4 cells are a type of white blood cell. They play a key role in the immune system. They alert other immune cells to the presence of infections such as bacteria and other viruses in the body. CD4 cells are also a subset of immune cells called T cells.
When a person is living with HIV, the virus attacks the CD4 cells in their blood. This process damages CD4 cells and causes a drop in the number of them in the body, making it difficult to fight infections. Monitoring CD4 cells is important for people who are receiving treatment for HIV.
CD4 counts vary widely. For many people, however, the higher a CD4 count is when they receive a diagnosis and start treatment, the more quickly they are likely to see it rise as a result of therapy. This is one reason why an early diagnosis is essential.
The chart below summarizes the ranges of CD4 counts:
|Under 200 cells/mm3||A doctor will diagnose AIDS.|
CD4 counts show the robustness of the immune system. A healthy immune system normally has a CD4 count ranging from 500 to 1,600 cells per cubic millimeter of blood , according to HIV.gov.
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When Cd4 Counts Don’t Increase
For a minority of patients, antiretroviral therapy may not boost CD4 counts as expected, but there are ways to increase the likelihood of success.
Timing is one of the most important factors. Starting treatment as soon as possible after diagnosis, when ones CD4 count has not yet been decimated, is associated with much better outcomes. If CD4 levels are already low when treatment is initiated, the drugs may struggle to generate a meaningful increase. Treatment may fail to boost CD4 counts to a healthy level in about 15 to 20% of those who have a very low number of CD4 cells from the start.
If CD4 levels remain low despite treatment, your doctor will likely consider what factors may be to blame, including certain medications, untreated infections or other conditions. Still, antiretroviral therapy is the best and only proven way to increase your CD4 count.
Results Reporting Critical Findings
The CD4 count normal range is 500 to 1500 cell/mm^3. If a patient is left untreated, levels can drop below 200 cells/mm^3, which is one indication for the diagnosis of AIDS. The broad range in the normal value is the product of three variables: the white blood cell count, the percentage of lymphocytes, and the percentage of lymphocytes that bears the CD4 receptor.
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Other Preventive Actions For People With Living With Hiv
In addition to getting a flu shot every year, people living with HIV should take the same everyday preventive actions CDC recommends of everyone, including avoiding people who are sick, covering coughs, and washing hands often.