Low CD4 Count, Isoniazid Treatment, Non-Response to Hep B Vaccination, Casual Sex

[boydoctor]

Hello Doctor,

I have a bit of problem classifying my question because there are many factors which I do not understand. However, I hope you will be able to shed some light to my situation.

Over the course of 2007 - 2008 I have had sexual activities with 5 - 6 other guys, of which I had anal sex with 2 of them on 4 instances. I am the top (insertive) partner in both instances. Sex with these guys were always protected. With the rest of them, I mainly had mutual masturbation and in two or three instances gave oral sex to these guys for periods that were less than a minute. I had otherwise always been the receiving end of oral sex.

As a foreign student in a health related degree (I entered in Feb 2007 (Australian acaedemic year begins in Feb and ends in Nov), I was asked to go for vaccinations and screenings to ensure that I am protected when I start clinical years.

Because I had a positive reading for a Mantoux test (more than 12mm), I was sent to a respiratory physician, who, despite knowing that I had my BCG done when I was 12 years old, decided to start me on a 6 month course on Isoniazid because he believed I had latent TB. This was done from Sep 2007 to March 2008.

In March 2007, I was also tested for Hep B immunity and was found that I did not have immunity to it. I was subsequently given a course of 4 single shots over a period of one year, and a blood test done in Feb 2008 showed that I still did not have immunity to it.

I was referred to an immunologist and I attended the clinic in Dec 2008, 2 weeks ago. He had ordered a blood test for me and suggested that I go for an intra-dermal course of 5 fortnightly Hep B vaccinations. However,when my blood test arrived, he informed me over the phone that while I have no Hep B infection (nor immunity), my CD4 count was 30% lower than normal. I am now extremely worried because I won't see him until after the New Year, I was hoping if you could shed some light onto what could affect CD4 levels and my risks of HIV.

[H. Hunter Handsfield, M.D.]

CD4 counts vary widely, certainly within a 30% range over the course of a day, so this might mean nothing at all.  There is nothing that can be done to raise CD4 counts.  Your immunologist undoubtedly knows this stuff better than I do; that would be the best source for additional questions.

In any case, since you are known to not have HIV (which probably will be confirmed with the new test), this whole business is off topic for this forum.  So that will have to end this thread.

[boydoctor]

Hello Doc,

Thanks for the response. Yes I did have a blood test done on HIV, HepB, HepC and Syphillis but I will receive the results tomorrow. In addition, I have done HIV test over the past years but they have always turned negative. However, the last one I did was in end 2006 before starting school in 2007.

I guess what I really wanted to know was what are the factors that could have affected CD4 counts because everything that turns up in a google search points to AIDS and HIV. The fact that my immunologist didn't really wanted to see me immediately (he said to come in Jan) when he was briefly telling me about my results over the phone didn't really allay my fears.

I am just really worried of the low CD4 count and wonder if any other lifestyle habits could have contributed to its causes, for example, my late night habits of only sleeping at 5am and getting up at 12 noon. Apparently I have gotten into this sleep pattern for about 2 months now because I was studying for exams, but I haven't gotten out of this habit since it finished in the last week of Nov. Is there anything I could also do, to boost up my CD4 count?

Sorry for not talking about my HIV tests, it was really late last night and it's a bit hard remembering everything. :)


Thanks.

[H. Hunter Handsfield, M.D.]

I would like to help, but you are asking an awfully complex series of questions that ought to be asked of the providers who you have been seeing for these various clinical issues.  The issue on your mind, which you come to rather indirectly, is whether you might have HIV to explain the low-ish CD4 count and the apparent failure to mount a measurable immune response to HBV vaccine.  (There is nothing in your TB-related history that implies any immune deficiency.)  Based on the sexual exposures you describe, HIV sounds unlikely -- but I can't say it is impossible.

What is quite surprising is that apparently you haven't been tested for HIV, or you would have said something about it.  That of course is what you need to do.  My bet is that it will be negative.  But until you are tested, all else is speculation.  You should discuss all this with the immunologist (or your health care provider of choice), including your sexual exposure history, then follow his or her advice for the details.

Best wishes--  HHH, MD

[boydoctor]

Allow me to correct myself, I was the top in all cases of anal sex, meaning all 4 instances ( I did it twice with each guy).

Thanks Doc! Sorry for the lengthy post!