A lot of people say that a low CD4 count is unimportant. I disagree. While I don’t think it PREDICTIVE of poor health, I do believe it may be INDICATIVE of poor health. Here’s some notes I’ve made with a summary link at the end. (Thanks Mike for suggesting Kremer’s book!)
I don’t believe in HIV. Since AIDS (as a definition) requires the existence of HIV I don’t believe in AIDS either. That being said, there have been people that have died from what are termed “AIDS defining illnesses”. There were deaths of gay men back in the early 1980s when it was known as GRID (Gay Related Immune Disorder). I almost died with pneumonia at a CD4 count of 50 and I was diagnosed HIV+ and wasn’t on HAART (Highly Active Anti Retroviral Treatment). I’ve had two friends locally that have been diagnosed HIV+ and have not taken HAART and both have been hospitalised with opportunistic infections and a low CD4 count. I agree that CD4 counts change for all manner of reasons and the way they are measured is variable and that they are not PREDICTIVE of health but they are INDICATIVE of health. If you get any good text on immunology they are part of the immune system.
I consider there are two aspects of the immune system that are important for people ‘diagnosed as HIV+’, but firstly, why do people test positive on the HIV ELISA test? The main reason is an excess of anti-body production and this is a possible sign the body is out of balance – something known as Th2 dominance. The first important aspect of the immune system is mucosal immunity and the second is CD4 count.
Mucosal immunity: Our body has skin on the outside to protect it from pathogens. On the inside (our ‘inner skin’) we have the mucosal layer from our nose to our anus (including the lungs, gastro-intestinal tract and colon). Our immune system resides predominantly within this mucosal layer. Think of a castle wall (mucosal layer) manned by soldiers (ie CD4 cells + other immune cells) and the invading army are the pathogens. If the castle wall is damaged (ie compromised mucosal immunity) or the soldiers (ie CD4 cells) are low in numbers, then the invading pathogens can easily invade and attack the human host. The mucosal layer can be compromised by using nitrate inhalers, ice (crystal meth), antibiotics, stress, poor diet, environmental toxins, etc.
CD4 count: It’s worth pointing out that there are three types of CD4 cells. Type 1 helper cells (Th1), type 2 helper cells (Th2) and type 17 helper cells (Th17). Th1 CD4 cells target opportunistic infections INSIDE the cells and are responsible for “cell-mediated immunity (CMI)”. Th2 CD4 cells support the bone marrow to produce B cells which generate anti-bodies and this is known as “humoral immunity” and targets what lay outside of the cell. Th17 CD4 cells target fungi (though I’m not sure by what mechanism they do this). What’s interesting to note is that a Th2 response requires the Th2 CD4 cells to LEAVE THE BLOOD and migrate to the bone and lymph. This leaves a decreased CD4 count in the blood plasma.
What leads to Th2 CD4 migration? When your mucosal immunity is compromised, then you can get a switch in CD4 immune cell profiles with an increase in the Th2 CD4 cells. This leads to increased CD4 migration and a lower CD4 count in the blood plasma. HAART reverses CD4 migration back into the blood but I won’t go into that here. An imbalance between Th1 and Th2 and an excess of Th2 is termed “Th2 dominance”. Th2 dominance can be observed in pregnant women as a way to protect the foetus. It can also be observed in people with helminth parasite infections. Th2 dominance is really only a problem when you also have depleted levels of glutathione (amongst other things).
Recall that Th1 CD4 cells kill opportunistic infections. They do this by emitting nitric oxide (NO). When the Th1 CD4 cells have depleted levels of intra-cellular glutathione, then the process of emitting nitric oxide will cause apoptosis (cell death) of the said CD4 cell. This leads to a further decline in Th1 CD4 cell count in the blood plasma and an increase in Th2 dominance, further perpetuating this vicious cycle.
As such , opportunistic infections can be explained by Th2 dominance without the need for HIV. While a low CD4 count is not significant by itself, it can be used to prompt a check for other factors (ie low levels of glutathione) and if you consider you have a problem, then you can work on rebuilding glutathione levels and switching back to a balance Th1/Th2 profile. This is not as easy to do as it appears as the whole process is rather complex. I’ve been working on this for two years and my CD4 count is still less than 50 (it’s been slowly declining since I stopped HAART in June 2012). That being said, I’ve been working on rebuilding my mucosal immunity and I’m now working on increasing glutathione levels.
For a more detailed reference, read Heinrich Kremer’s book “The Silent Revolution in Cancer and AIDS Medicine”. This site is a good reference: http://web.archive.org/web/20111223130828/http://aliveandwellsf.org/faq