Interesting Times

T-Cell Blues or Will I Get AIDS?

 

The question uppermost in the minds of many of us infected with the AIDS virus, who have not yet developed any major problems is wilt I get AIDS? For many, one of the most difficult issues is deciding what physical symptoms to pay attention to and which to ignore. One of the most important things to remember if you are antibody positive is that you will continue to get ill and get better just as you would if you were not infected with the virus. Getting sick once in a while, having colds or the flu, is a natural part of everyone's life and this continues even for those of us carrying the AIDS virus.

Unfortunately, many of the early signs that AIDS virus infection may be going from dormant to active are very general viral symptoms that could reflect infection with many things other than the AIDS virus. Symptoms such as fever, an occasional night sweat, swollen lymph nodes, diarrhea, etc, are very common and things most of us experience at least a couple of times a year, unrelated to the AIDS virus. The most important component with most of these symptoms is whether or not they are persistent Any of these lasting for more than a few days should probably be checked out by your physiciaa

The one set of symptoms that an HIV infected person should always deal with immediately are those related to your lungs and breathing. A persistent dry cough and/or shortness of breath (getting winded easily with normal exertion) should be checked out as soon as possible with your health care provider. I am of the school of thought that it is very rare to have AIDS sneak up on you. By that I mean you don't go to bed at night feeling great and wake up the next morning with pneumocystis pneumonia We are all aware of friends or people we've heard about who seem to just get sick out of the blue and are dead in a week or two. I do believe that the onset of the AIDS pneumonia can be very subtle and some people do become very ill very fast However, in the vast majority of instances people usually experience months, sometimes years of chronic (Le. nagging, recurrent persistent) symptoms that may be indicative of the AIDS virus infection slowly activating from a dormant phase. It may be difficult for health care providers to attach direct or impending significance to things like recurrent skin problems, occasional night sweats, diarrhea, mouth (hairy leukoplakia) or gum problems, or recurrent herpes simplex and herpes zoster (shingles). These problems can be very anxiety provoking for those of us who are infected. ' Currently it is not known how many people infected will go on to develop AIDS. The percentage of those predicted to become ill continues to increase, based on studies where small groups of gay men are followed who have been infected since the late seventies. It is known with certainty that these men have been infected for years because their blood was frozen during hepatitis B vaccine trials and then later thawed and tested when the AIDS virus antibody test became available In the San Francisco study, about one-third have developed AIDS and an additional one-third have developed chronic swollen lymph nodes and/or ARC symptoms within six to seven years of initial HIV infection.

There is a test that may give us an idea about what shape the immune system is in and whether or not AIDS may develop in the near future, Le, a test for the number of T-r helper cells.

We can think of our white blood cells as our immune system or defense against disease These are the cells that protect us from invading germs (bacteria fungus, virus, etc.). There are several types of white blood cells. Lymphocytes are one type of which there are two major kinds: B*s and Ts. B-lymphocytes make antibodies and T-lymphocytes are actually cell killing (attacking infected cells). There are two types of T-lymphocytes we are concerned with, T-helpers and T-suppressors. The AIDS virus must get into the blood stream where it primarily infects the helper cell If the virus is stimulated and begins reproducing, attacking, and killing enough of these cells, you begin to get sick. The virus itself may not make you ill, but rather kills off enough of the T helper cells and then organisms in the environment to which we are repeatedly exposed, get out of control and cause illness.

The normal number of T helper cells can range between 400-1500 per cubic millimeter of blood, depending on the laboratory. The normal number of T-suppressor cells is between 250 and 750 per cubic millimeter of blood, again the range of normal can vary depending on the laboratory. In non-infected individuals there are usually two T-helpers for every one T-suppressor — 2:1 or a ratio of 2. Actually, a ratio anywhere between 1 and 2 is considered normal Most individuals infected with the AIDS virus have a ratio less than one even if in good health with no AIDS symptoms. Usually, during the first several years (and sometimes after many years) of infection with the AIDS virus, the number of T-helper cells is normal (between 400-1 500) and the ratio of helpers to suppressors is between 0.5-1.0. During this period your immune system functions fine and you should not have any AIDS related symptoms.

It is very important to emphasize here that the T-helper value can fluctuate with an individual over a relatively short period of time. If you do decide to have your T-helper count done, keep in mind that these fluctuations can occur and this is probably normal. If you have a T-helper count between 200 and 400, you should be followed more closely by your health care provider than if your count were higher. It would be a good idea to have the count repeated again in a few months or sooner if other clinical symptoms of HIV infection begin to occur. If you have a T-helper count of less than 200, your current physical status should be closely scrutinized by your health care provider.

Many antibody positive gay men are starting to have their T-helper counts followed. An important thing to keep in mind is that AZT (Retrovir) is available to anyone with symptomatic HIV infection 'whose T-cell count is less than 200. Some people with 200 T-cel!s may only experience nagging ARC symptoms that are not very serious and they are capable of working full time. Most private, health insurance will pickup at least 80% of the cost of AZT. If you have a diagnosis of ARC, it is imperative that you have your T-heiper count checked and if 200 or less, discuss with your physician the possibility of taking AZT. Research with AZT and ARC patients has been very promising. If you have a diagnosis of full-blown AIDS with less than 200 T-helper cells you also qualify for the drug.

If you are antibody positive and in good health with no symptoms, then having T-ceils checked is much less imperative. You might want one set done to establish a base line.

If you do decide to get your T-helper count if s important to have someone interpret these numbers who understands their meaning based on current AIDS information and is familiar with your current and past state of health. Remember, these are not static values. The number of circulating lymphocytes in the blood frequently varies with lymphocytes moving back and forth between the blood and lymphatic systems. If you've had some ARC symptoms and have a count around 200, follow this closely. If you are in good health, have had no symptoms and have a borderline count (300-400), DO NOT PANIC. You may want to repeat them in a few months after conferring with your health care provider about the best course of action for you. No single number or lab value should ever replace how you feel and physically present to your health care provider.

Obtaining a T-cell count or an "immune system panel" is not cheap. There are only a few labs in town that do these counts, so your health care provider will most certainly have to send them out to be done. I had mine done last fall and just had it billed to my insurance. Be careful!! Realize that you are making a potential statement about your antibody status to your insurance company by having this test done. If you wish to keep this sort of information from your insurance cornpany(by paying for it yourself) or you do not have health insurance, the cost can be in the neighborhood of $60.00 to $100.00. It may be possible to have only a T-cell count and not the whole panel done much cheaper. Have your physician check this out with the lab he or she uses for this test

We are at a time when we all need to be more assertive about managing our own HIV infections. Passively waiting in a closet for the cure is just not going to cut it. No one is going to come knocking and say you can come out now, it's safe and we've found the cure!

Be well!

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