Normal number of CD4 cells in 1 µl. CD4 (t-cell) analyzes. Preparation for analysis

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 (the previous one was about this).
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 - treatment is successful if 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's easier to assess the failure - if the cells began to fall during the 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. Of course, there are successful attempts and schemes, science is working in this direction, but at the level of every clinic and every infectious disease specialist - no, 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 subtle 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 decrease in viral load is already 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, the 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, while 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 arising 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 believe 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 is 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 a special room from the hands of a nurse, 5 days a week, from 8 to 4. Such rooms 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, it is not analyzes that are considered, but a person and his specific life (infectionist patients 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.

Or Acquired Immune Deficiency Syndrome. AIDS) is considered the terminal stage of HIV infection, which is characterized by a critical decrease in the level of CD4 blood lymphocytes and in which secondary, so-called. AIDS-associated infectious and oncological diseases acquire an irreversible course, resistant to specific treatment. AIDS is inevitably fatal.

CD4 lymphocytes (sometimes called T cells or helper cells) are a special type of white blood cell that is a major component of the human immune system. Human immunodeficiency viruses, getting into the physiological fluids of the body, spread there and destroy these cells, which leads to a catastrophic destruction of immunity. A diagnosis of AIDS can be made with positive HIV tests and a CD4 count below 200 cells/mL. Coming at the same time, deep violations of the immunity of the human body, destruction of the main barrier of protection lead to the fact that the ability to resist the joined secondary, opportunistic diseases is lost. Thus, CD4-lymphocytes are markers of the degree of impaired immunity, which make it possible to determine the transition of HIV infection to its terminal stage - AIDS. The test for CD4 lymphocytes allows you to determine the number of these cells in a cubic milliliter of blood.

Another criterion for the transition of HIV infection to the stage of AIDS for adults and adolescents is the presence of AIDS-associated diseases in them, which are grouped into the following groups:

Bacterial infections:

• Pulmonary and extrapulmonary tuberculosis.
• Severe bacterial or recurrent pneumonia (two or more episodes within 6 months).
• Infection caused by atypical mycobacteria (Mycobacterium avium), disseminated mycobacteremia.
• Salmonella septicemia.

Fungal infections:

• Candida esophagitis.
• Cryptococcosis, extrapulmonary, cryptococcal meningitis.
• Histoplasmosis, extrapulmonary, disseminated.
• Pneumocystis pneumonia caused by Pneumocystis jirovecii.
• Extrapulmonary coccidioidomycosis.

Viral infections:

• Herpes simplex virus infection herpes simplex virus,HSV): chronic or persistent for more than 1 month, chronic ulcers on the skin and mucous membranes or bronchitis, pneumonitis, esophagitis.
• Cytomegalovirus infection with damage to any organ except the liver, spleen and lymph nodes, cytomegalovirus retinitis.
• Human herpesvirus type 8 infection Kaposi Sarkoma Herpes Virus, KSHV).
• Human papillomavirus infection Human papillomavirus, HPV), including cervical cancer.
• Progressive multifocal leukoencephalopathy.

Protozoal infections:

• Cryptosporidiosis with diarrhea lasting more than a month.
• Microsporidiosis.
• Isosporiasis, with diarrhea for more than a month.

Other diseases:

• Kaposi's sarcoma.
• Cervical cancer, invasive.
• Non-Hodgkin's lymphoma.
• HIV encephalopathy, HIV dementia.
• HIV wasting syndrome.
• vacuolar myelopathy.

The causative agents of these diseases for healthy people in most cases are not dangerous. Many of them live freely in water, soil, human skin and mucous membranes. A healthy immune system reliably resists them, and for AIDS patients in whom it is destroyed, these organisms turn from neutral agents into mortal enemies.

Indications for an AIDS test

• Treatment of HIV infection.
• AIDS.

Preparation for analysis

It is enough to follow a few rules to get the right result. It is recommended to limit yourself in food 8-14 hours before the test, as it is better to take it on an empty stomach. The result can distort alcohol and nicotine, so it is also better to refuse. Eliminate heavy physical exertion and, if possible, protect yourself from stress.

How is the procedure?

Blood is taken from the cubital vein according to standard technology.

Interpretation of the result of the analysis for AIDS

As evidenced by the number of CD4-lymphocytes

Without treatment, the number of CD4 cells in the body begins to gradually decline. It is important to keep an eye on this indicator to help you and your doctor make timely decisions about treatment and other support.

CD4 count - 350: initiation of HIV treatment

HIV treatment should be started when the CD4 count falls below 350. It is at this level that starting treatment is most effective: the immune system is more likely to recover to normal. If you start treatment with a CD4 count of about 350, you will almost certainly not develop HIV-related illnesses. It has also been shown to reduce the risk of heart disease, kidney disease, liver disease, and cancer. Be prepared for the fact that at this stage the doctor will begin to talk with you about the treatment. A decrease in the level of CD4-lymphocytes below 350 cells/µl is an indication for the appointment of highly active antiretroviral therapy (HAART).

CD4 count of 200 or less: starting HIV treatment and taking prophylactic drugs

If the number of CD4-lymphocytes has decreased below 200, it is necessary to urgently decide on the start of therapy, since with such indicators the disease takes on a particularly severe course due to AIDS-associated diseases. Additional drugs should be taken to prevent the development of these diseases (such treatment is called prophylactic). When the CD4 count returns, prophylaxis can be discontinued. The course of the disease becomes irreversible when the number of CD4-lymphocytes drops below 50 cells per 1 µl.

CD4 count during HIV treatment

After the start of treatment for HIV infection, the level of CD4-lymphocytes will gradually increase. The growth rate of CD4 cells depends on the individual characteristics of each person. For some people, it may take months or even years for their CD4 counts to return to normal. If you start treatment with a very low CD4 count, it will take a long time for it to rise. It should be remembered that even a small increase in the number of CD4 cells can have a very positive effect on your health. Once you start treatment, you should have your CD4 count and viral load tested every three to six months.

Percentage of CD4 cells

In addition to the CD4 count test, doctors sometimes use the CD4 percentage test, which measures the percentage of CD4 cells in the entire population of lymphocytes. In people who are HIV negative, the percentage of CD4 cells is 40%. When compared as a percentage to a count, a CD4 count of about 14% is considered to have the same risk of developing comorbidities as a CD4 count of ≤ 200. A physician may use a CD4 percentage method if, for example, your two consecutive CD4 count tests made a big difference.

Expected complications depending on the number of CD4 lymphocytes

If you are not taking HIV medications, have relatively high CD4 counts, and have no adverse symptoms, you should have a CD4 count every three to four months (or once every six months if your count is high enough).

Once you start HIV treatment, the frequency of your CD4 count tests will depend on your facility's protocols and your current CD4 count. On average, such an analysis is prescribed every three to six months. With the appearance of additional symptoms or a deterioration in well-being, the analysis should be taken more often.

Norms

In a person not infected with HIV, the number of CD4 lymphocytes ranges from 450 to 1600, but in some cases it can be higher or lower, and the content of CD4 among other lymphocytes is 40%. Women tend to have higher CD4 counts than men. The number of CD4 cells can also vary, depending on factors such as stress, smoking, menstrual cycle, contraceptive use, recent physical activity, and even the time of day. The number of CD4 lymphocytes decreases in the case of an infectious or other disease. If you become ill—for example, if you get the flu, or if you have herpes—postpone the test until you are fully recovered.

Diseases for which a doctor may order an AIDS test

1. AIDS

   To establish the diagnosis of AIDS, the following points must be confirmed: the number of CD4 cells in the blood is below 200 per milliliter; the content of CD4 among other lymphocytes is less than 14%.

CD4 count(full name: CD4+ T cell count, or CD4+ T cell count, or T4, or immune status) is a blood test result that shows how many of these cells are in a cubic millimeter of blood.

The CD4 count is a very good "surrogate marker". It indicates how severely HIV has affected the immune system, what is the depth of the infectious process, what is the risk of other infections, when should treatment be started. The average number of CD4 cells for an HIV-negative person ranges from 600 to 1900 cells/ml of blood, although this level may be higher or lower in some people.

2-3 weeks after infection, the CD4 count usually drops.

As the immune system begins to resist, the CD4 count rises again, although not to its original level.

In the future, over the years, the number of CD4 gradually decreases. The average annual decline in CD4 counts is about 50 cells/mm3. For each individual, this rate is individual, depends on many factors, such as the subtype of the virus, the age of the person, the route of HIV transmission, genetic characteristics (presence or absence of CCR5 receptors) and may be higher or lower.

The immune system of most people successfully controls HIV without requiring treatment for many years.

CD4+ Cell Count is a blood test that measures how well the immune system is functioning in people with the human immunodeficiency virus (HIV). CD4+ cells are a type of white blood cell. Leukocytes play an important role in the fight against infections. CD4+ cells are also called T lymphocytes, T cells, or T helpers.

HIV infects CD4+ cells. The CD4+ cell count helps determine if other infections (opportunistic infections) may occur. The trend of the CD4+ cell count is more important than the value of a single test, because it can change from day to day. The trend of CD4+ cell count over time demonstrates the effect of the virus on the immune system. In untreated HIV-infected people, the CD4+ cell count usually decreases as HIV progresses. A low CD4+ count often indicates a weakened immune system and a higher chance of developing opportunistic infections.

Why testing is done

The measurement of the CD4+ cell count is carried out in order to:

Observing how HIV infection affects your immune system.

Help to diagnose Acquired Immune Deficiency Syndrome (AIDS) in time. HIV leads to AIDS, a long-term chronic illness with no cure.

Determining when is the best time to start antiretroviral therapy, which will reduce the rate of HIV infection in the body. For more information, see the "Results" section.

Determine your risk of developing other infections (opportunistic infections).

Determine when is the best time to start preventive treatment for opportunistic infections, such as taking medication to prevent Pneumocystis Pneumonia (PCP).

The CD4+ cell count determined at the time you were diagnosed with HIV serves as a baseline against which all subsequent CD4+ cell counts will be compared. Your CD4+ count will be measured every 3-6 months, depending on your health, previous CD4+ count, and whether you are taking highly active antiretroviral therapy (HAART).

How to prepare for the test

Before taking this test, consult a specialist who will advise you on the meaning of the test results. Find out how this test is related to your HIV infection.

How the test is done

The health worker conducting the blood draw will perform the following steps:

Put an elastic band around your arm above the elbow to stop the blood flow. This enlarges the veins that are below the level of the dressing, making it easier for the needle to enter the vein.

Wipe the needle with alcohol.

Insert a needle into a vein. More than one attempt may be needed.

Attach a blood sampling tube to the needle.

When the required amount of blood has collected, he will remove the bandage from your arm.

Apply a gauze compress or cotton swab to the skin puncture site with a needle after removing it.

First, he will press the puncture site, and then apply a bandage.

What will it feel like

You may not feel anything during the injection, or you may feel some pain as the needle passes through your skin. Some people experience burning pain while the needle is in the vein. However, most people experience no (or minimal) discomfort while inserting a needle into a vein. Your pain will depend on the skill of the healthcare professional taking the blood sample, as well as the condition of your veins and your sensitivity to pain.

HIV is a virus that attacks the immune system. In our immune system, there are a large number of cells that perform various functions:

• Leukocytes;
• Phagocytes;
• macrophages;
• Neutrophils;
• T-helpers (CD4-lymphocytes);
• T-killers.

Each of these cells is responsible for a certain stage of the response to a foreign object. HIV infects only one group of cells - CD4 lymphocytes (T-lymphocytes). They are responsible for recognizing a foreign gene.

By the number of certain cells, the doctor draws conclusions about the patient's condition. The AIDS test is based on the number of T-lymphocytes (CD4-lymphocytes) in a blood sample.

Diseases for which a doctor may order an AIDS test

If a blood test shows an indefinite connective tissue disease, an inflammatory process, an HIV test may be prescribed. A good marker of HIV is a sharp decrease in CD4-lymphocytes. In the case when other infections and a predisposition to a certain group of diseases (colds, for example) are detected, an HIV test is not performed.

Important! If an inflammatory process that has no basis is found, it is necessary to take an HIV test.

Do not be afraid if the doctor starts talking about an HIV test. The diagnosis may not be confirmed. With a positive result, it is important to start treatment as soon as possible.

Norms

• Overwork of the body;
• Menstrual cycle;
• epidemiological environment;
• Some medicines.

The number of T-lymphocytes (helpers) is restored after rest.

If the absolute CD4 count does not recover within a certain period, the doctor may order an HIV test.

Interpretation of the result of the analysis for AIDS

In a healthy person, all indicators should be normal. If one of the parameters is changed, a viral load test is assigned. After that, the results of the blood test are correlated with this indicator. This will help you determine the cause of the violation.

The lymphocyte count decreases in the case of an infectious disease, but is restored after a course of treatment to a normal level. There will be no improvement in system performance in HIV patients. The test is based on this.

What is immune status

When determining the immune status of a person, blood parameters are examined:

• Total and relative number of lymphocytes;
• Number of t-lymphocyte helpers;
• Phagocytic activity of macrophages;
• Changes in immunoglobulins of different classes.

Of all the above, only T-lymphocytes are specific to HIV.

Important! A decrease in CD4-lymphocytes indicates a terrible disease. An increase in their level indicates another inflammatory process.

What does the CD4 count say?

CD4 cells are contained in the blood in a certain amount. If there is a decrease in them, the body quickly restores the number. When the immune system is suppressed, the number of lymphocytes decreases, the activity of T-suppressors, on the contrary, leads to the activation of protective forces.

Viral cells multiply very quickly, so when infected with HIV, the level of T-lymphocytes cannot recover to normal levels.

Changes in CD4 count

CD4 cells are the first to respond to the penetration of a foreign agent into the body. A decrease in the level indicates a high activity of the virus.

The number of cells/µl may vary depending on:

• Time of day (in the morning it is higher);
• The presence of infectious diseases;
• The process of processing blood (with the wrong procedure, cells can be destroyed);
• The medications taken (hormonal and steroid drugs significantly affect this indicator).

Percentage of CD4

When testing for HIV, blood counts are often expressed as a percentage.

Helpers CD3, D8, CD19, CD16+56, as well as the ratio of CD4 CD8 decreases with a decrease in the immune status. But these parameters do not indicate HIV.

Only the CD4 helper is specific to the immunodeficiency virus:

• If its content is 12-15%, then in terms of the blood contains 200 cells / mm 3;
• At values ​​from 29%, the content of cells is from 450 cells/mm 3 ;

In an HIV-negative person, the value of this parameter is 40%.

When immune cells are damaged, immunity decreases. to determine the rate of this process, the viral load is calculated - the amount of foreign RNA per ml of blood. This parameter is predictive.

The immune system of women is weaker, so the viral load indicator, according to the results of the study, begins to decline much earlier than in men.

What does an undetectable viral load mean?

The viral load indicator may not be determined after a few months. Depending on the activity of the virus, its number in the blood may vary. Then, with a low sensitivity of the apparatus, it will not detect the virus.

Important! An indeterminate viral load does not mean that the virus has completely disappeared. Treatment for AIDS should not be stopped, because without treatment, remission will occur and the amount of the virus will increase.

The effect of vaccinations and infections

Vaccination or an infectious disease temporarily increases the viral load. Taking prophylactic drugs, on the contrary, reduces. To accurately determine the immune status after the above procedures, you should wait for some time. The period will be set by the doctor depending on the circumstances.

What are the benefits of an undetectable viral load?

In HIV-positive people, an undetectable viral load can occur if:

• Proper antiretroviral therapy;
• Low progression of the virus.

This contributes to the normalization of the patient's condition. With multiple repeated courses, immunological tolerance may develop. The immunological response in this case ceases to respond to treatment. In this case, it is necessary to change the course of treatment. This can happen if:

• The course of treatment was not completed;
• The same course was repeated several times in a row;
• Individual insensitivity to prescribed drugs.

natural variations

The virus can be in the body in several stages:

• incubation stage;
• Period of acute infection;
• latent stage;
• Stage of secondary diseases;

During different periods of activity, viral load indicators change significantly. Within a few days, this parameter can change three times, regardless of the course of treatment. Sharp short-term jumps may not affect the health of the patient. The determination of drug resistance is carried out several times. The final result is calculated as an average.

The use of suppressors leads to the stabilization of the number of viruses in the blood.

Significant changes

If the number of HIV viruses remains high for several months, it is worth paying attention to this. Important indicators exceeding the norm by 3-5 times. If the increase in the level of CD4-lymphocytes passes during the course of treatment, it may be necessary to change medications, since the body has lost its sensitivity to them.

Variance minimization

When taking an analysis for the amount of immunodeficiency virus, CD4-lymphocytes in the blood, it should be understood that different devices have different sensitivities. It may differ depending on the instrument brand or calibration value. In order to minimize the error associated with the devices, the analysis should be taken in the same clinic on the same device.

If one of the partners in the family is HIV-positive, there is a certain schedule in sexual life. If the viral load rises, you should completely refrain from sexual contact, as the likelihood of infection increases significantly.

By lowering the threshold for the number of viruses, using certain medications on the recommendation of a doctor, sexual activity can be resumed.

What is the threshold for determining current tests

Sensitive modern tests for the diagnosis of HIV is gradually increasing. Most devices in Russia are sensitive to the amount of virus 400-500 pieces/ml of blood. Some more expensive devices detect the virus by the standard method at a count of 50/ml.

The literature indicates that some modern models are able to recognize HIV at a population of only 2 pieces/ml of blood, but such technologies are not yet used in hospitals and private clinics.

Mistakes

Despite the high sensitivity of modern devices, errors still occur in determining viral load values. They are associated with:

• Incorrect calibration of the device;
• Poor handling of flasks from previous assays;
• Incorrectly prepared blood sample;
• The presence in the blood of drugs that reduce sensitivity.

These errors are corrected by re-analyzing the same blood sample or a new portion.

Decision to start antiretroviral therapy

If the tests show a high viral load for a long period of time, the doctor decides on the appointment of a course of treatment. The beginning of treatment for HIV infection and taking medications does not begin immediately, but gradually. Most drugs are introduced into the course of treatment over a certain period, so that the body gets used to a significant amount of aggressive chemical components. The number of CD4 lymphocytes in the blood plays an important role in making such a decision.

In the event that a person cannot or does not want to start treatment, he must constantly take an analysis and monitor the level of lymphocytes in the blood.

Advice! If you have not started antiretroviral therapy, get tested for HIV and your CD4 count on a regular basis. If you miss a critical minimum, the body may not be able to cope. Recovery will take much more time, money and effort.

If you have an increase in viral load while on therapy

If the viral load continues to increase after starting treatment, there may be two options:

• Not enough treatment time has passed to restore normal parameters;
• The body is not sensitive to prescribed drugs.

The decision on further actions is made by the doctor based on the tests and the patient's condition.

How to improve your viral load test results

As a result of proper treatment, the amount of cd4 in the blood should gradually be restored.

This will also help:

• Proper nutrition;
• Rejection of bad habits;
• No stress;
• No fatigue.

If you are not taking antiretroviral therapy

When deciding whether to start a course of treatment or not, it is important to understand what antiretroviral therapy is for HIV AIDS. These drugs are aimed at suppressing the activity of the virus outside the cells of the body. Due to this, during therapy, the immune system is restored in patients.

In the complex of drugs there are also those that contribute to the restoration of the body's natural defenses.

In the absence of such therapy, the virus has the ability to multiply freely, affecting more and more cells of the host's immune system.

CD4 count(full name: CD4+ T cell count, or CD4+ T cell count, or T4, or immune status) is a blood test result that shows how many of these cells are in a cubic millimeter of blood.

The CD4 count is a very good "surrogate marker". It indicates how severely HIV has affected the immune system, what is the depth of the infectious process, what is the risk of other infections, when should treatment be started. The average number of CD4 cells for an HIV-negative person ranges from 600 to 1900 cells/ml of blood, although this level may be higher or lower in some people.

2-3 weeks after infection, the CD4 count usually drops.

As the immune system begins to resist, the CD4 count rises again, although not to its original level.

In the future, over the years, the number of CD4 gradually decreases. The average annual decline in CD4 counts is about 50 cells/mm3. For each individual, this rate is individual, depends on many factors, such as the subtype of the virus, the age of the person, the route of HIV transmission, genetic characteristics (presence or absence of CCR5 receptors) and may be higher or lower.

The immune system of most people successfully controls HIV without requiring treatment for many years.

CD4+ Cell Count is a blood test that measures how well the immune system is functioning in people with the human immunodeficiency virus (HIV). CD4+ cells are a type of white blood cell. Leukocytes play an important role in the fight against infections. CD4+ cells are also called T lymphocytes, T cells, or T helpers.

HIV infects CD4+ cells. The CD4+ cell count helps determine if other infections (opportunistic infections) may occur. The trend of the CD4+ cell count is more important than the value of a single test, because it can change from day to day. The trend of CD4+ cell count over time demonstrates the effect of the virus on the immune system. In untreated HIV-infected people, the CD4+ cell count usually decreases as HIV progresses. A low CD4+ count often indicates a weakened immune system and a higher chance of developing opportunistic infections.

Why testing is done

The measurement of the CD4+ cell count is carried out in order to:

Observing how HIV infection affects your immune system.

Help to diagnose Acquired Immune Deficiency Syndrome (AIDS) in time. HIV leads to AIDS, a long-term chronic illness with no cure.

Determining when is the best time to start antiretroviral therapy, which will reduce the rate of HIV infection in the body. For more information, see the "Results" section.

Determine your risk of developing other infections (opportunistic infections).

Determine when is the best time to start preventive treatment for opportunistic infections, such as taking medication to prevent Pneumocystis Pneumonia (PCP).

The CD4+ cell count determined at the time you were diagnosed with HIV serves as a baseline against which all subsequent CD4+ cell counts will be compared. Your CD4+ count will be measured every 3-6 months, depending on your health, previous CD4+ count, and whether you are taking highly active antiretroviral therapy (HAART).

How to prepare for the test

Before taking this test, consult a specialist who will advise you on the meaning of the test results. Find out how this test is related to your HIV infection.

How the test is done

The health worker conducting the blood draw will perform the following steps:

Put an elastic band around your arm above the elbow to stop the blood flow. This enlarges the veins that are below the level of the dressing, making it easier for the needle to enter the vein.

Wipe the needle with alcohol.

Insert a needle into a vein. More than one attempt may be needed.

Attach a blood sampling tube to the needle.

When the required amount of blood has collected, he will remove the bandage from your arm.

Apply a gauze compress or cotton swab to the skin puncture site with a needle after removing it.

First, he will press the puncture site, and then apply a bandage.

What will it feel like

You may not feel anything during the injection, or you may feel some pain as the needle passes through your skin. Some people experience burning pain while the needle is in the vein. However, most people experience no (or minimal) discomfort while inserting a needle into a vein. Your pain will depend on the skill of the healthcare professional taking the blood sample, as well as the condition of your veins and your sensitivity to pain.