UNDERSTANDING LAB TESTS - CD4 CELL COUNT TESTS
A regular part of HIV health care involves having blood tests done every 3-6 months to monitor your overall health, the progression of HIV disease, your immune system's response to medications that you are taking, and any medication-related side effects or complications. Some of the most common laboratory tests done are the CD4 cell count, HIV viral load, blood chemistry (includes liver and kidney function tests), blood lipid panels (cholesterol, blood fats), blood sugar tests, and complete blood count, or CBC (checks for low white cell counts and anemia). It is important for a person who is being treated for any chronic disease to be educated about the disease and its treatment in order to be a true "partner" in their own health care. HIV is no exception. You should know what lab tests are being done, what they are measuring or monitoring, and the implications of the results. In this post I will discuss the CD4 cell count (T Cells).
In order to understand how HIV breaks down the immune system, it is important for you to have a basic understanding of how the immune system works when it is healthy and not compromised by HIV. The immune system is one of the most complex systems in the human body. HIV harms the body's immune system by targeting and infecting the CD4 cells, or T-cells, which are a type of white blood cell whose purpose in the body is to resist infection and protect the body from illness. The CD4 cells are a major part of the body's natural first-line defense against illness. Once inside the CD4 cells, HIV takes over the cells and turns them into "virus factories" within the body, making thousands of copies of itself in each cell. As the amount of virus grows, the original CD4 cell is damaged and eventually destroyed. HIV eventually kills so many of these cells that the immune system is weakened and the body is no longer able to defend itself against infections (bacteria, viruses, parasites, molds) and certain cancers. If left untreated, HIV can lead to the development of opportunistic infections, AIDS, and death.
So, why do you need to know all of this? Because you need to understand how HIV affects the immune system in order to understand and appreciate the role of antiretroviral medications (drugs used to treat HIV and AIDS) in your treatment plan. I have found from dealing with patients that those patients who had a good basic understanding of how the medications worked and why it was important to keep the CD4 cell count higher remained healthier and had much better medication adherence rates and fewer missed doses.
Your HIV specialist will monitor many laboratory tests besides the absolute CD4 cell count, which is the measurement of the total number of CD4 cells (T cells) in your body; this reflects the health of your immune system. They will also monitor the CD4 cell percentage and the ratio of CD4 to CD8 cells, but as a start you should focus on the absolute number of CD4 cells. A normal, healthy person who is not infected with HIV has a CD4 count of 500-16oo cells; this number varies from day to day, depending on the physical and emotional strssors on the body. In an HIV infected person, the CD4 count declines gradually as HIV kills more and more cells. The more CD4 cells a person has, the stronger the immune system is; a CD4 cell count above 500 indicates that the immune system is fairly intact, and the chances of becoming sick are minimal. As the CD4 count decreases, the chances of permanent immune system damage and of developing symptoms of HIV disease are increased. That is why most HIV specialists will begin to discuss starting antiretroviral medications (ARV) to treat the HIV when your CD4 count is between 350-500. United States Government guidelines currently recommend starting ARV medications when the CD4 cell count falls below 350, but this starting point is constantly being debated by the experts and thought-leaders in the field as the risks of opportunistic illness and the toxicities of the medications are considered and compared. If the CD4 count falls below 2oo, your disease has progressed from HIV to AIDS, and you are at a high risk for developing certain opportunistic illnesses; your provider will prescribe certain medications to try to prevent some of these illnesses, but it will be important for you to also take the ARV medications that are prescribed to treat the HIV/AIDS in order to hopefully bring your CD4 count up again. Studies have shown that waiting too long to start treatment with ARV medications and letting the CD4 cell count drop to low may compromise the ability of the immune system to respond to the ARV medications.
A common question is "how long from the time of infection with HIV will it take for the CD4 cells to fall to the level where ARV medications are needed?". This is very difficult to answer, because there are many different variables to consider. First of all, it depends on the CD4 count at baseline. When HIV infection occurs initially, there will be a very rapid rise in HIV viral load and a decrease in the CD4 cell count as the body responds to the acute infection. Over a period of 3-6 months, the CD4 count will stabilize at a somewhat consistent level, and it is predicted that on average about 45 CD4 cells will be lost every 6 months, with slightly higher numbers lost with very high counts. Obviously, it will take longer to progress to needing medications if one starts off with a CD4 count in the high 800's (which is not at all uncommon) than if the baseline CD4 count is 350. This decrease of 45 cells every 6 months is an average, and there are many other factors to consider. Lifestyle plays a very important role in the destruction of CD4 cells, with factors such as high stress, drug use, alcohol abuse, and smoking causing some dramatic drops in CD4 cells in many cases. That is why you will be educated thoroughly about lifestyle changes and the importance of good nutrition, exercise, and sleep habits from the beginning of your treatment. All of these things will affect your overall health and the progression of the disease.
Once you begin ARV medications, your CD4 count should begin to increase slowly. The CD4 count will fluctuate normally throughout treatment, so it is important not to be too overly concerned about or place to much emphasis on a single result. Most HIV specialists will track your results over time on a graph or flow-chart, and you can download a tracker and do this yourself also. Remember, those who actively participate in their care remain healthier and do better overall; you and your provider are equal partners in the fight against HIV/AIDS.
In order to understand how HIV breaks down the immune system, it is important for you to have a basic understanding of how the immune system works when it is healthy and not compromised by HIV. The immune system is one of the most complex systems in the human body. HIV harms the body's immune system by targeting and infecting the CD4 cells, or T-cells, which are a type of white blood cell whose purpose in the body is to resist infection and protect the body from illness. The CD4 cells are a major part of the body's natural first-line defense against illness. Once inside the CD4 cells, HIV takes over the cells and turns them into "virus factories" within the body, making thousands of copies of itself in each cell. As the amount of virus grows, the original CD4 cell is damaged and eventually destroyed. HIV eventually kills so many of these cells that the immune system is weakened and the body is no longer able to defend itself against infections (bacteria, viruses, parasites, molds) and certain cancers. If left untreated, HIV can lead to the development of opportunistic infections, AIDS, and death.
So, why do you need to know all of this? Because you need to understand how HIV affects the immune system in order to understand and appreciate the role of antiretroviral medications (drugs used to treat HIV and AIDS) in your treatment plan. I have found from dealing with patients that those patients who had a good basic understanding of how the medications worked and why it was important to keep the CD4 cell count higher remained healthier and had much better medication adherence rates and fewer missed doses.
Your HIV specialist will monitor many laboratory tests besides the absolute CD4 cell count, which is the measurement of the total number of CD4 cells (T cells) in your body; this reflects the health of your immune system. They will also monitor the CD4 cell percentage and the ratio of CD4 to CD8 cells, but as a start you should focus on the absolute number of CD4 cells. A normal, healthy person who is not infected with HIV has a CD4 count of 500-16oo cells; this number varies from day to day, depending on the physical and emotional strssors on the body. In an HIV infected person, the CD4 count declines gradually as HIV kills more and more cells. The more CD4 cells a person has, the stronger the immune system is; a CD4 cell count above 500 indicates that the immune system is fairly intact, and the chances of becoming sick are minimal. As the CD4 count decreases, the chances of permanent immune system damage and of developing symptoms of HIV disease are increased. That is why most HIV specialists will begin to discuss starting antiretroviral medications (ARV) to treat the HIV when your CD4 count is between 350-500. United States Government guidelines currently recommend starting ARV medications when the CD4 cell count falls below 350, but this starting point is constantly being debated by the experts and thought-leaders in the field as the risks of opportunistic illness and the toxicities of the medications are considered and compared. If the CD4 count falls below 2oo, your disease has progressed from HIV to AIDS, and you are at a high risk for developing certain opportunistic illnesses; your provider will prescribe certain medications to try to prevent some of these illnesses, but it will be important for you to also take the ARV medications that are prescribed to treat the HIV/AIDS in order to hopefully bring your CD4 count up again. Studies have shown that waiting too long to start treatment with ARV medications and letting the CD4 cell count drop to low may compromise the ability of the immune system to respond to the ARV medications.
A common question is "how long from the time of infection with HIV will it take for the CD4 cells to fall to the level where ARV medications are needed?". This is very difficult to answer, because there are many different variables to consider. First of all, it depends on the CD4 count at baseline. When HIV infection occurs initially, there will be a very rapid rise in HIV viral load and a decrease in the CD4 cell count as the body responds to the acute infection. Over a period of 3-6 months, the CD4 count will stabilize at a somewhat consistent level, and it is predicted that on average about 45 CD4 cells will be lost every 6 months, with slightly higher numbers lost with very high counts. Obviously, it will take longer to progress to needing medications if one starts off with a CD4 count in the high 800's (which is not at all uncommon) than if the baseline CD4 count is 350. This decrease of 45 cells every 6 months is an average, and there are many other factors to consider. Lifestyle plays a very important role in the destruction of CD4 cells, with factors such as high stress, drug use, alcohol abuse, and smoking causing some dramatic drops in CD4 cells in many cases. That is why you will be educated thoroughly about lifestyle changes and the importance of good nutrition, exercise, and sleep habits from the beginning of your treatment. All of these things will affect your overall health and the progression of the disease.
Once you begin ARV medications, your CD4 count should begin to increase slowly. The CD4 count will fluctuate normally throughout treatment, so it is important not to be too overly concerned about or place to much emphasis on a single result. Most HIV specialists will track your results over time on a graph or flow-chart, and you can download a tracker and do this yourself also. Remember, those who actively participate in their care remain healthier and do better overall; you and your provider are equal partners in the fight against HIV/AIDS.
posted by Laurie @ 1/30/2007
2 Comments
2 Comments:
Thanks nice providing information.
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