Undetectable viral load but low CD4 count
Usually, HIV treatment leads to substantial falls in the quantity of HIV in the body, as measured by the viral load test. Following this, the immune system usually strengthens and as a result the CD4 count increases.
However, a few people find that their CD4 cell count does not improve much. Researchers wanted to find out what impact this has on their health.
They looked at data on over 5000 people living with HIV in Europe and North America. All were starting HIV treatment ‘late’ (with a CD4 cell count below 200) but all went on to have an undetectable viral load for at least three years. What’s more, most of them had significant increases in their CD4 count.
However, one-in-seven people’s CD4 count did not rise above 200. This was more likely to be the case for older people and for individuals starting HIV treatment with an especially low CD4 count (for example, below 100).
The researchers found that these individuals had a greater risk of dying. For example, whereas 12% of people with a CD4 count below 200 had died five years later, 2% of people with a CD4 count above 500 had died.
Many of the deaths were related to cancer or hepatitis. The researchers therefore recommend that patients whose CD4 count has not significantly improved despite otherwise successful treatment should be closely monitored for cancers, hepatitis and other diseases.
The study also underlines the importance of starting HIV treatment before the CD4 count is very low.
Thinking about talking to your doctor about HIV treatment at your next appointment? Our online tool, Talking points, can help you prepare for that conversation. Visit www.aidsmap.com/talking-points
HIV treatment for children
Anti-HIV drugs are often provided to infants and children in a liquid form, as a syrup. But, when researchers asked people to measure a dose, about half made mistakes.
Adults living with HIV were asked to measure a dose of the drug AZT. When using a measuring cup, people tended to provide too much drug (this could lead to increased side-effects). When using an oral syringe, people tended to provide too little drug (which could lead to HIV not being fully suppressed).
People with less education and less understanding of how to look after their own health were more likely to make mistakes.
This study was conducted in Mozambique, but similar results have been seen in research from the United States. One limitation of the study is that participants didn’t necessarily have children who were taking HIV treatment, and so they may not have had experience of measuring out medicines.
Nonetheless, the study shows how easy it is to make mistakes. It underlines the importance of HIV clinic staff showing parents how to measure medicines accurately – if your child is taking HIV treatment, the pharmacists, doctors and nurses at the clinic can give you advice on this.
Editors' picks from other sources
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Dallas Buyers Club tackles the complex question of who should decide what drugs dying patients can take, and makes for a compelling but also frustrating film.
Françoise Barré-Sinoussi: 'Ruling out a cure for AIDS would not be French'
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The scientist who helped discover the HIV retrovirus talks about her work and why she is convinced a cure for AIDS can be found.
HIV-positive nurse tried by media
from AIDS Free World
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