HIV treatment – CD4 cell count

Antiretroviral treatment means that many people with HIV can now expect to live a long and healthy life.

Treatment suppresses viral load, which allows the immune system – assessed by monitoring CD4 cell count – to recover.

Most people taking HIV treatment experience a gradual increase in their CD4 cell count.

However, some people achieve an undetectable viral load, but their CD4 cell count doesn’t increase.

New European research has shown that people in this situation need extra monitoring and care.

Researchers looked at the CD4 cell counts of over 66,000 people whose viral load fell to undetectable levels after starting HIV treatment.

They looked at the risk of developing a new AIDS-defining illness or dying.

Results showed that the prognosis for patients with a CD4 cell count above 500 was excellent. Patients with a CD4 cell count above 350 also had a good outlook.

But the prognosis was much poorer for people with a CD4 cell count below 200.

“In virologically suppressed patients an increase in CD4 cells reduces the risk of AIDS or death,” comment the investigators, “lack of increase in CD4 cell count is relevant for prognosis and poorer outcome.”

Your CD4 cell count is regularly monitored as part of routine HIV care. Rather than focusing on a single result it’s important to look at a trend in your results, which will allow you and your doctor to make appropriate treatment decisions.

HIV treatment – viral load

The goal of HIV treatment is an undetectable viral load. This doesn’t mean that you’ve been cured of HIV, rather that the level of virus in your blood is so low that it cannot be detected using standard tests (normally this means it is below 40 or 50 copies/ml).

HIV treatment is now so good that an undetectable viral load is the realistic aim for most people.

However, researchers have now found that having a low but detectable viral load is associated with an increased risk of drug resistance.

The study involved over 1100 people starting HIV treatment for the first time.

Around 6% of patients had a viral load between 50 and 1000 copies/ml. This is considered to be a low viral load, but is still detectable by standard tests.

Over two-thirds of these patients subsequently suppressed their viral load to an undetectable level.

But further analysis showed that 37% of patients with low detectable viral load developed drug-resistant strains of HIV.

Some people developed resistance when their viral load was between 100 and 200 copies/ml.

This finding especially concerned the researchers – new guidance has suggested that people should only switch their treatment if their viral load increases above 200 copies/ml.

Hepatitis C – new drug boceprevir

Many people with HIV are co-infected with hepatitis C. Liver disease caused by hepatitis C is a major cause of serious illness and death in these patients.

Treatment is available for hepatitis C. It currently consists of two drugs – pegylated interferon and ribavirin. The aim of this treatment is a cure.

However, it doesn’t always work and can cause unpleasant side-effects.

A number of new hepatitis C drugs have recently been approved or are in development.

One is the protease inhibitor boceprevir (Victrelis). It’s used in combination with existing hepatitis C drugs and has been shown to improve outcomes.

An important factor affecting the success of hepatitis C therapy is the virus genotype.

Hepatitis C genotypes 1 and 4 are harder to treat than genotypes 2 and 3.

Now researchers have found that the success of boceprevir therapy depends on which strain of genotype a patient has.

Better responses were seen in people with genotype 1b than genotype 1a. People with genotype 1b were also less likely to develop drug resistance.

The research was conducted in people who were only infected with hepatitis C – it didn’t include people who also had HIV.

There’s currently a lot of debate about the best way to use newer hepatitis C drugs in people who also have HIV.

Your routine hepatitis C care will include a test to see which hepatitis C genotype you have.

For more information, you can read or download our patient information booklet HIV & hepatitis from our website.