Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. I have been on Viread, Ziagen, and Zerit for 1-1/2 years. My T-cells at first went up from 40 to 240 within one month, after a medication vacation. And my viral load remains undetectable but t-cells have gone down to 190 presently.
Should I consider changing to possibly Sustiva, Ziagen and Viread? I have been on
Zerit since 1996. Hope you can help?
Thank you
Lisa Capaldini, M.D.
Internal Medicine
There are several factors involved to best answer your question. Put in medical terms, you're concerned that while your VIROLOGIC response is great (undetectable viral load), IMMUNOLOGICALLY (your T-cells) you may be losing ground.
First of all, are your T-cells REALLY lower? Sometimes the T-cell count appears to change in a way that doesn't accurately reflect the strength of the immune system. It's a math issue: the T-cell count is calculated from a larger pool of lymphocytes. If something (a viral infection, stress) affects the entire lymphocyte population the T-cells will be affected in a way that MISLEADINGLY suggests the T-cells are better or worse; one way to double-check T-cells is to look at the T-cell percentage -- if your absolute T-cell has dropped from 240 to 190 but your percentage hasn't dropped, your T-cell change is probably clinically insignificant, or to use a practical term, a fakeout.
But let's say your T-cell pool IS lower (the percentage is lower, the absolute count is lower) AND your viral load is undetectable; one number is worse, the other is perfect. We call this a discordance: there isn't a good fit between the T-cells being worse and the viral load being great. I don't think this situation has been formally researched so I'll just give you my opinion: if your viral load is undetectable, switching meds is unlikely to improve your T-cell profile. If your current meds are easy for you to take and you have no side effects, I wouldn't switch them: that would be like taking a pitcher out of the game too early!
These discordant situations are puzzling to everyone, and, the good news is that if your viral load stays undetectable, your immune system will function well.
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