Viral Load

Are CD4-Cell Counts Still Necessary?

In stable HIV-infected patients, results contributed virtually nothing to medical decision making.

The CD4-cell count has been a pivotal tool in HIV care since the late 1980s, when it first achieved its reputation as a reliable and convenient objective marker of immune deficiency. And now, hard as it may be to believe, we may not need it any more — at least not in the care of stable patients.

To explore this possibility, investigators probed the records of all patients attending a single HIV clinic in Washington, D.C., at any time from September 1998 through December 2011 to identify those with continuous long-term HIV suppression. Among patients with CD4 counts between 200 and 249 cells/mm3 at the start of suppression, risk for a subsequent CD4 dip to <200 cells/mm3 was 25%; among those with counts between 250 and 299, risk was 16%; among those with counts between 300 and 349, risk was 5%; and among those with counts ≥350, risk was 2%. When patients with an unrelated cause for an alteration in CD4-cell count such as severe infection, chemotherapy, or interferon treatment were excluded from the analysis, not a single patient in any group had a dip in CD4 count below 200 cells/mm3 after 2 years of continuous virologic control. Comment: These results formalize what most of us have independently realized: For stable patients, the periodic CD4-cell count check is an entirely meaningless ritual. Patients may still follow their "numbers" carefully and fret when the values fall, but physicians generally ignore fluctuations in these highly variable measurements. However, as an editorialist points out, in order to wean ourselves from "this wasteful addiction," we have two sizeable tasks: first, persuading oversight programs to acknowledge that viral load is the only meaningful marker of treatment efficacy, and second, persuading patients of the sizeable benefits of foregoing monitoring, which can be measured in money saved, tubes of blood not drawn, and peace of mind. - See more at: http://aids-clinical-care.jwatch.org/cgi/content/full/2013/225/1#sthash.KGsVbJsE.NW5wD89g.dpuf Are CD4-Cell Counts Still Necessary? In stable HIV-infected patients, results contributed virtually nothing to medical decision making. The CD4-cell count has been a pivotal tool in HIV care since the late 1980s, when it first achieved its reputation as a reliable and convenient objective marker of immune deficiency. And now, hard as it may be to believe, we may not need it any more — at least not in the care of stable patients. To explore this possibility, investigators probed the records of all patients attending a single HIV clinic in Washington, D.C., at any time from September 1998 through December 2011 to identify those with continuous long-term HIV suppression. Among patients with CD4 counts between 200 and 249 cells/mm3 at the start of suppression, risk for a subsequent CD4 dip to <200 cells/mm3 was 25%; among those with counts between 250 and 299, risk was 16%; among those with counts between 300 and 349, risk was 5%; and among those with counts ≥350, risk was 2%. When patients with an unrelated cause for an alteration in CD4-cell count such as severe infection, chemotherapy, or interferon treatment were excluded from the analysis, not a single patient in any group had a dip in CD4 count below 200 cells/mm3 after 2 years of continuous virologic control. Comment: These results formalize what most of us have independently realized: For stable patients, the periodic CD4-cell count check is an entirely meaningless ritual. Patients may still follow their "numbers" carefully and fret when the values fall, but physicians generally ignore fluctuations in these highly variable measurements. However, as an editorialist points out, in order to wean ourselves from "this wasteful addiction," we have two sizeable tasks: first, persuading oversight programs to acknowledge that viral load is the only meaningful marker of treatment efficacy, and second, persuading patients of the sizeable benefits of foregoing monitoring, which can be measured in money saved, tubes of blood not drawn, and peace of mind. - See more at: http://aids-clinical-care.jwatch.org/cgi/content/full/2013/225/1#sthash.KGsVbJsE.NW5wD89g.dpuf Are CD4-Cell Counts Still Necessary? In stable HIV-infected patients, results contributed virtually nothing to medical decision making. The CD4-cell count has been a pivotal tool in HIV care since the late 1980s, when it first achieved its reputation as a reliable and convenient objective marker of immune deficiency. And now, hard as it may be to believe, we may not need it any more — at least not in the care of stable patients. To explore this possibility, investigators probed the records of all patients attending a single HIV clinic in Washington, D.C., at any time from September 1998 through December 2011 to identify those with continuous long-term HIV suppression. Among patients with CD4 counts between 200 and 249 cells/mm3 at the start of suppression, risk for a subsequent CD4 dip to <200 cells/mm3 was 25%; among those with counts between 250 and 299, risk was 16%; among those with counts between 300 and 349, risk was 5%; and among those with counts ≥350, risk was 2%. When patients with an unrelated cause for an alteration in CD4-cell count such as severe infection, chemotherapy, or interferon treatment were excluded from the analysis, not a single patient in any group had a dip in CD4 count below 200 cells/mm3 after 2 years of continuous virologic control. Comment: These results formalize what most of us have independently realized: For stable patients, the periodic CD4-cell count check is an entirely meaningless ritual. Patients may still follow their "numbers" carefully and fret when the values fall, but physicians generally ignore fluctuations in these highly variable measurements. However, as an editorialist points out, in order to wean ourselves from "this wasteful addiction," we have two sizeable tasks: first, persuading oversight programs to acknowledge that viral load is the only meaningful marker of treatment efficacy, and second, persuading patients of the sizeable benefits of foregoing monitoring, which can be measured in money saved, tubes of blood not drawn, and peace of mind. - See more at: http://aids-clinical-care.jwatch.org/cgi/content/full/2013/225/1#sthash.KGsVbJsE.NW5wD89g.dpuf Are CD4-Cell Counts Still Necessary? In stable HIV-infected patients, results contributed virtually nothing to medical decision making. The CD4-cell count has been a pivotal tool in HIV care since the late 1980s, when it first achieved its reputation as a reliable and convenient objective marker of immune deficiency. And now, hard as it may be to believe, we may not need it any more — at least not in the care of stable patients. To explore this possibility, investigators probed the records of all patients attending a single HIV clinic in Washington, D.C., at any time from September 1998 through December 2011 to identify those with continuous long-term HIV suppression. Among patients with CD4 counts between 200 and 249 cells/mm3 at the start of suppression, risk for a subsequent CD4 dip to <200 cells/mm3 was 25%; among those with counts between 250 and 299, risk was 16%; among those with counts between 300 and 349, risk was 5%; and among those with counts ≥350, risk was 2%. When patients with an unrelated cause for an alteration in CD4-cell count such as severe infection, chemotherapy, or interferon treatment were excluded from the analysis, not a single patient in any group had a dip in CD4 count below 200 cells/mm3 after 2 years of continuous virologic control. Comment: These results formalize what most of us have independently realized: For stable patients, the periodic CD4-cell count check is an entirely meaningless ritual. Patients may still follow their "numbers" carefully and fret when the values fall, but physicians generally ignore fluctuations in these highly variable measurements. However, as an editorialist points out, in order to wean ourselves from "this wasteful addiction," we have two sizeable tasks: first, persuading oversight programs to acknowledge that viral load is the only meaningful marker of treatment efficacy, and second, persuading patients of the sizeable benefits of foregoing monitoring, which can be measured in money saved, tubes of blood not drawn, and peace of mind. — Abigail Zuger, MD Published in Journal Watch HIV/AIDS Clinical Care February 25, 2013 - See more at: http://aids-clinical-care.jwatch.org/cgi/content/full/2013/225/1#sthash.KGsVbJsE.NW5wD89g.dpuf Are CD4-Cell Counts Still Necessary? In stable HIV-infected patients, results contributed virtually nothing to medical decision making. The CD4-cell count has been a pivotal tool in HIV care since the late 1980s, when it first achieved its reputation as a reliable and convenient objective marker of immune deficiency. And now, hard as it may be to believe, we may not need it any more — at least not in the care of stable patients. To explore this possibility, investigators probed the records of all patients attending a single HIV clinic in Washington, D.C., at any time from September 1998 through December 2011 to identify those with continuous long-term HIV suppression. Among patients with CD4 counts between 200 and 249 cells/mm3 at the start of suppression, risk for a subsequent CD4 dip to <200 cells/mm3 was 25%; among those with counts between 250 and 299, risk was 16%; among those with counts between 300 and 349, risk was 5%; and among those with counts ≥350, risk was 2%. When patients with an unrelated cause for an alteration in CD4-cell count such as severe infection, chemotherapy, or interferon treatment were excluded from the analysis, not a single patient in any group had a dip in CD4 count below 200 cells/mm3 after 2 years of continuous virologic control. Comment: These results formalize what most of us have independently realized: For stable patients, the periodic CD4-cell count check is an entirely meaningless ritual. Patients may still follow their "numbers" carefully and fret when the values fall, but physicians generally ignore fluctuations in these highly variable measurements. However, as an editorialist points out, in order to wean ourselves from "this wasteful addiction," we have two sizeable tasks: first, persuading oversight programs to acknowledge that viral load is the only meaningful marker of treatment efficacy, and second, persuading patients of the sizeable benefits of foregoing monitoring, which can be measured in money saved, tubes of blood not drawn, and peace of mind. — Abigail Zuger, MD Published in Journal Watch HIV/AIDS Clinical Care February 25, 2013 - See more at: http://aids-clinical-care.jwatch.org/cgi/content/full/2013/225/1#sthash.KGsVbJsE.NW5wD89g.dpuf Are CD4-Cell Counts Still Necessary? In stable HIV-infected patients, results contributed virtually nothing to medical decision making. The CD4-cell count has been a pivotal tool in HIV care since the late 1980s, when it first achieved its reputation as a reliable and convenient objective marker of immune deficiency. And now, hard as it may be to believe, we may not need it any more — at least not in the care of stable patients. To explore this possibility, investigators probed the records of all patients attending a single HIV clinic in Washington, D.C., at any time from September 1998 through December 2011 to identify those with continuous long-term HIV suppression. Among patients with CD4 counts between 200 and 249 cells/mm3 at the start of suppression, risk for a subsequent CD4 dip to <200 cells/mm3 was 25%; among those with counts between 250 and 299, risk was 16%; among those with counts between 300 and 349, risk was 5%; and among those with counts ≥350, risk was 2%. When patients with an unrelated cause for an alteration in CD4-cell count such as severe infection, chemotherapy, or interferon treatment were excluded from the analysis, not a single patient in any group had a dip in CD4 count below 200 cells/mm3 after 2 years of continuous virologic control. Comment: These results formalize what most of us have independently realized: For stable patients, the periodic CD4-cell count check is an entirely meaningless ritual. Patients may still follow their "numbers" carefully and fret when the values fall, but physicians generally ignore fluctuations in these highly variable measurements. However, as an editorialist points out, in order to wean ourselves from "this wasteful addiction," we have two sizeable tasks: first, persuading oversight programs to acknowledge that viral load is the only meaningful marker of treatment efficacy, and second, persuading patients of the sizeable benefits of foregoing monitoring, which can be measured in money saved, tubes of blood not drawn, and peace of mind. — Abigail Zuger, MD Published in Journal Watch HIV/AIDS Clinical Care February 25, 2013 - See more at: http://aids-clinical-care.jwatch.org/cgi/content/full/2013/225/1#sthash.KGsVbJsE.NW5wD89g.dpuf Are CD4-Cell Counts Still Necessary? In stable HIV-infected patients, results contributed virtually nothing to medical decision making. The CD4-cell count has been a pivotal tool in HIV care since the late 1980s, when it first achieved its reputation as a reliable and convenient objective marker of immune deficiency. And now, hard as it may be to believe, we may not need it any more — at least not in the care of stable patients. To explore this possibility, investigators probed the records of all patients attending a single HIV clinic in Washington, D.C., at any time from September 1998 through December 2011 to identify those with continuous long-term HIV suppression. Among patients with CD4 counts between 200 and 249 cells/mm3 at the start of suppression, risk for a subsequent CD4 dip to <200 cells/mm3 was 25%; among those with counts between 250 and 299, risk was 16%; among those with counts between 300 and 349, risk was 5%; and among those with counts ≥350, risk was 2%. When patients with an unrelated cause for an alteration in CD4-cell count such as severe infection, chemotherapy, or interferon treatment were excluded from the analysis, not a single patient in any group had a dip in CD4 count below 200 cells/mm3 after 2 years of continuous virologic control. Comment: These results formalize what most of us have independently realized: For stable patients, the periodic CD4-cell count check is an entirely meaningless ritual. Patients may still follow their "numbers" carefully and fret when the values fall, but physicians generally ignore fluctuations in these highly variable measurements. However, as an editorialist points out, in order to wean ourselves from "this wasteful addiction," we have two sizeable tasks: first, persuading oversight programs to acknowledge that viral load is the only meaningful marker of treatment efficacy, and second, persuading patients of the sizeable benefits of foregoing monitoring, which can be measured in money saved, tubes of blood not drawn, and peace of mind. — Abigail Zuger, MD Published in Journal Watch HIV/AIDS Clinical Care February 25, 2013 - See more at: http://aids-clinical-care.jwatch.org/cgi/content/full/2013/225/1#sthash.KGsVbJsE.NW5wD89g.dpuf Thank you: http://aids-clinical-care.jwatch.org/cgi/content/full/2013/225/1# The AIDS CD4 T-Cell Test: A Measure of Fat? by Cal Crilly Well I swap the odd message with a HIV+ lady in Europe when I get to a net cafe every couple of weeks as I don’t know if anyone else does. In her last couple of messages she said she “was worried about her CD4 count going down as the doctors would then harass her to take antiretrovirals” which in the past made her very sick. She also said that while her CD4 went down she felt better and heather than ever… So I looked. I have been an observer of the AIDS story for a good 13 years now, if I wander into a net cafe it’s because I noticed something you need to know. I may be wrong about these observations but if I don’t mention them then no one else will say it…. So to me it looks like CD4 is mainly a marker for cholesterol and arterial plaque not the immune system. CD4 and CD8 counts goes up with cholesterol and nicotinamide will make cholesterol and CD4 go down because it’s a fat metaboliser. CD4 cells gather at the areas of arterial plaque and tell white blood cells to come and gobble up the cholesterol. Well that’s one thing they do along with cytokine signaling do but the levels of cholesterol in your blood will affect your T-cells count and no one is being told this. Or that CD4 T-cells are involved in arterial repair and remodeling and here are examples…. “These data indicate that following endothelial cell damage CD4+ T cell infiltration participates in pulmonary vascular remodeling. This suggests that a CD4+ T cell immune response may contribute to the pathogenesis of inflammatory vascular lesions seen in some forms of pulmonary hypertension.” Perivascular T Cell Infiltration Leads to Sustained Pulmonary Artery Remodeling After Endothelial Cell Damage [LINK]. “Conclusions: From these results, we demonstrated that PSGL-1-expressing CD4 T cells are enriched in the culprit coronary artery lesion of acute coronary syndrome, contributing to the acceleration of plaque instability…” PSGL-1-Expressing CD4 T Cells are Enriched in Culprit Coronary Artery Lesion of Acute Coronary Syndrome [LINK] Or that the increase in CD4 cells with HAART treatment actually gives you heart disease. “This study produced the surprising finding that people with higher CD4 counts were more likely to develop coronary artery disease.” “Increased vascular age is frequent among HIV-infected patients and appears to be associated with CD4+ cell count,” the investigators concluded. “If these findings were to be confirmed in prospective trials, a positive response to ART with an increase in CD4+ cell count may become a marker of increased risk of atherosclerosis development.” HIV Positive Men Have More Atherosclerosis and Higher Vascular Age than Uninfected Men [LINK] Increased prevalence of arterial hypertension in patients with HIV infection on HAART. [LINK] So they found a diet with extra fat makes CD4 go up but the only vitamin that lowers cholesterol Niacin lowers CD4, go figure? “Conclusions: Except for niacin, we found no consistent significative associations between micro-nutrient or fat intake and the rate of CD4 decline. The findings also suggest that a high dietary composition of vegetable fat and several specific fatty acids may be associated with a delay in the occurrence of AIDS.” Micronutrient and fat intake in relation to CD4 decline and occurrence of AIDS in a cohort of HIV-infected men [LINK] The Niacin only made the T-cells go down because it makes LDL cholesterol go down. “Therapy with niacin (nicotinic acid) is unique in that it improves all lipoprotein abnormalities. It significantly reduces low-density lipoprotein cholesterol, triglyceride, and lipoprotein(a) levels, while increasing high-density lipoprotein cholesterol levels.” New perspectives on the use of niacin in the treatment of lipid disorders.[LINK] But Niacin or Nicotinamide also lowers HIV levels….. Nicotinamide: An Oral Antimicrobial Agent with Activity against Both Mycobacterium tuberculosis and Human Immunodeficiency Virus. [LINK] While here is a good example of cholesterol raising T-cells…. “While native LDL activated CD4 T-cells to only a small extent, mechanically stressed (vortexed) LDL potently activated CD8 T-cells.” Activation of T-lymphocytes by LDL-cholesterol.[LINK] And CD8 seems to be a good thing but these ‘controllers’ may just eat more fatty foods…. HIV controllers exhibit potent CD8 T cell capacity to suppress HIV infection ex vivo and peculiar cytotoxic T lymphocyte activation phenotype [LINK] Eat more fat this study says. “CONCLUSIONS: Higher CD4 lymphocyte counts were associated with higher lipid levels” Increased serum lipids are associated with higher CD4 lymphocyte count in HIV-infected women [LINK] Or just plain old white blood cells increase as well in HIV negative people who are fatter. “Mean values of waist circumference, total adipose tissue and subcutaneous adipose tissue were significantly higher in the group with the higher WBC count.” White blood cell count and abdominal fat distribution in female obese adolescents. [LINK] “The researchers found that, after controlling for age, men who were most physically fit had the lowest levels of groups of white blood cells. Combining the groups of white blood cells created a measure of total white blood cell count, which is used as a marker for inflammatory activity. High total white blood cell counts have also been associated with illness and death from coronary heart disease. High levels of white blood cells were associated with higher levels of body fat as measured by body-mass index” Effects Of Fatness And Fitness On White Blood Cell Counts [LINK] So this study may be a clue and the trick may be to eat lots of Omega 6 fatty acids but take all the protective things for the heart. “Recipients fed the (n-6) PUFA rich diet had ?25% greater in vivo expansion of CD4+ T cells than lard- and fish oil–fed recipient mice” “In summary, we are the first to demonstrate that dietary PUFAs affect antigen-driven expansion of naïve CD4+ T cells in vivo. Surprisingly, (n-3) PUFA consumption did not reduce CD4+ T-cell expansion.” Dietary Polyunsaturated Fatty Acids Modulate In Vivo, Antigen-Driven CD4+ T-Cell Proliferation in Mice [LINK] This is where to find these fats…. (: Foods With High Omega-6 Essential Fatty Acids Omega-6 fatty acids It gets weirder as Omega 6 oils seems to have antiretroviral properties….. “Mice receiving the omega 3 diet died significantly sooner than those receiving the omega 6 diet.” Prolongation of survival in retrovirally induced T cell lymphoma by dietary omega 6 fatty acid. [LINK] Long-chain n-6 polyunsaturated fatty acids in breast milk decrease the risk of HIV transmission through breastfeeding. [LINK] Breast milk has heaps of Omega-6 plus our own anti-retrovirals anyway called abzymes which are needed to slow down the retroviral activity post pregnancy. Peculiarities of abzymes from sera and milk of healthy donors and patients with autoimmune and viral diseases [LINK] But HIV appears where cholesterol is so you still need to have the nutrients to break down cholesterol and prevent heart disease as well as HIV (whatever that is)…. “Cellular cholesterol is essential for HIV replication and may control HIV spread. HIV, in turn, appears to control cholesterol metabolism.” Association between HIV replication and cholesterol in peripheral blood mononuclear cells in HIV-infected patients interrupting HAART [LINK] Vitamin C is needed for proper collagen production and the immune system white blood cells. But it is also involved in cholesterol metabolism so if you take too much Vitamin C you’ll lower cholesterol and therefore T-cells. Just like Niacin so if you take too much Vitamin C without eating enough fat then T-cells may lower. “Ascorbic acid administered orally at a dose of 2 gm per day for 15 days to hypercholesterolemic cardiac patients significantly reduced serum total cholesterol and low density lipoprotein cholesterol, and significantly increased high density lipoprotein cholesterol.” Effect of ascorbic acid on serum cholesterol in hypercholesterolemic cardiac patients [LINK] But Glutathione is definitely good…. “[A] significant rise in CD4+ lymphocyte count, a reduction in HIV RNA plasma level of 0.8 log, an enhanced lymphocyte proliferation and an increased level of intracellular glutathione in CD4+ lymphocytes were found.” Virological and immunological effects of antioxidant treatment in patients with HIV infection [LINK] Intracellular glutathione levels in T cell subsets decrease in HIV-infected individuals. [LINK] I think of possible problems too if you take Lysine to control Herpes as Lysine is the building block for your arteries so if you take a lot your arteries and skin will be heathy but you may also have less cholesterol. Anyway you can all decide for yourselves from this data whether CD4 is really the marker for your immune system or just shows how much fat is in our blood. Remember all the fat deposits that occur with AIDS drugs and lipodystrophy will leave more cholesterol floating around too. FacialWasting.org Lipodystrophy and HIV Here’s a comment from Natalia after I raised this subject, sums it up doesn’t it? “I read about study about drug abusers, when they go off their drugs, their CD4 go low – why is that if body is cleanzing and getting healthier without drugs? I know about one guy – very heavy drug abuser – he has no place on his skin where …to inject his drugs! 10 years with heroin. He is poz for 10 years and has CD4 about 700-900 all the time. AIDS doctors never prescribed him any ARV because his CD4 is high. Another my poz friend was a professional sportman athlete, very healthy, not even alcohol, no smoking, training all the time. Seven years ago he got HIV+ and his CD4 were very low right away – AIDS doctor prescribed him ARV right away. He had very bad side effects, but he never felt any symptoms of “AIDS” before that with his low CD4.” Once upon a time a doctor would check your White and Red Blood Cells and then give you a dose of antibiotics if your White Blood Cells were low or a pint of Guiness if your Red Blood Cells were. We now with modern medicine have a syndrome I would call TDS. Toxic Diagnosis Syndrome where a doctor finds someone with nothing has everything…. And then poisons them with everything when they need nothing. That’s AIDS for you. Thank you: http://reducetheburden.org/is-the-aids-cd4-t-cell-test-a-measure-of-fat/ More quotes on CD4 counts and exercise. The humorous thing is how doctors take some of the healthiest people in the world, see 'bad' immune system numbers, and predict that the athletes will get sick ... they don't question the validity of their numbers. "resistance exercise [e.g. weight lifting] leads to acute changes in leukocyte counts, despite moderate hormonal changes, independent of training status. Regular resistance exercise might lead to decreased T-helper cell counts and a lower CD4/CD8 ratio, which could increase susceptibility to infections [which only indicates that doctors’ faith in their numbers outweighs the obvious facts in front of their eyes]" Ramel A et al. Acute impact of submaximal resistance exercise on immunological and hormonal parameters in young men. J Sports Sci. 2003 Dec; 21(12): 1001–8. http://davidcrowe.ca/SciHealthEnv/papers/9966-ResistanceExercise-ImmuneHormoneParameters-YoungMen.pdf "There was a significant reduction in CD4+ T cells at peak exercise in RA [rheumatoid arthritis] and SLE [lupus] patients and an increase after exercise in SLE patients. [but if CD4 counts are specific to HIV immune suppression, this cannot happen]" Pool AJ et al. Serum cortisol reduction and abnormal prolactin and CD4+/CD8+ T-cell response as a result of controlled exercise in patients with rheumatoid arthritis and systemic lupus erythematosus despite unaltered muscle energetics. Rheumatology (Oxford). 2004 Jan; 43(1): 43–8. http://davidcrowe.ca/SciHealthEnv/papers/9967-ExerciseImpacts-LabMarkers-RA-SLE.pdf "moderate exercise reaching or exceeding the VT [ventilatory threshold] level acutely affects T cell [including CD4+] and NK cell subsets" Saito Y et al. Effects of exercise intensity on circulating leukocyte subpopulations. Environ Health Prev Med. 2003 Mar; 8(1): 18–22. http://davidcrowe.ca/SciHealthEnv/papers/9968-ExerciseEffectOnLeukocytes.pdf "The CD3+ T-cell concentration rose at the end of exercise and then returned to baseline levels 2 h post-exercise. The CD4+ and the CD8+ lymphocytes followed the same pattern. At the end of exercise, the CD4+ and CD8+ populations increased and then returned to baseline levels 2 h after exercise. [this claims that CD4 counts rise after exercise, whereas most research shows that CD4 counts decline during exercise. CD4 counts during exercise were not measured in this study]" Ibfelt T et al. Exercise-induced change in type 1 cytokine-producing CD8+ T cells is related to a decrease in memory T cells. J Appl Physiol (1985). 2002 Aug; 93(2): 645–8. http://davidcrowe.ca/SciHealthEnv/papers/9969-ExerciseDecreasesMemoryTCells.pdf "Prolonged strenuous exercise is followed by a temporary functional immune impairment. Low numbers of CD4+ T helper (Th) and CD8+ T cytotoxic (Tc) cells are found in the circulation." Steensberg A et al. Strenuous exercise decreases the percentage of type 1 T cells in the circulation. J Appl Physiol (1985). 2001 Oct; 91(4): 1708–12. http://davidcrowe.ca/SciHealthEnv/papers/9970-ExerciseDecreasesType1TCells.pdf "The relationship between exhaustive exercise, oxidative stress, the protective capacity of the antioxidant defense system and cellular immune response has been determined. Exhaustive exercise in well-trained young men (n=19)-induced leukocytosis, decreased proportion of activated-lymphocyte subsets (CD4+ and CD8+) expressing CD69...Suppressed blood concentration of T-lymphocyte subsets (CD3+, CD4+, CD8+, NK), increased TAS and blood total glutathione (TGSH) in early recovery period (30 min after exercise) were found." Vider J et al. Acute immune response in respect to exercise-induced oxidative stress. Pathophysiology. 2001 Mar; 7(4): 263–270. http://davidcrowe.ca/SciHealthEnv/papers/9971-AcuteImmuneResponseDueToExerciseOxidativeStress.pdf "The purpose of this study was to evaluate the nutritional status of a group of 10 young female elite gymnasts aged 13-17 years, who do a physical exercise of 48 h/wk...The results were compared with a control group consisting of 50 volunteer students doing less than 12 h/wk of physical exercise, who were matched by sex, age, and sociocultural level...The lymphocyte and leukocyte counts were also lower in gymnasts in relation to controls, except CD19 and CD56 subsets which were similar in both groups. It is suggested that gymnasts are at risk of malnutrition, which when compounded with intense physical exercise could lead to immunosuppression in these athletes. [so, some of the healthiest, most active, fittest and hardest working young people are actually sickly, according to doctors who are blinded by the numbers]" López-Varela S et al. Nutritional status of young female elite gymnasts. Int J Vitam Nutr Res. 2000 Jul; 70(4): 185–90. "The purpose of the present study was to investigate the role of plasma amino acids and glutathione (GSH) on the absolute number of leukocyte and lymphocyte subpopulations in response to different training programs. Healthy untrained subjects were randomly assigned to an 8-wk aerobic (AET) or anaerobic (ANT) exercise training program. Absolute number of cell counts did not significantly change in AET, whereas a decrease of CD4+ T cell counts (P < 0.05), a fall in cells expressing CD45RA+ antigen (P < 0.05), and a marked increase in CD8+ T cell numbers (P < 0.01) were noted in ANT at the end of the training period compared with baseline values...our data indicate impairment of the number and activity of CD4+ T cells in response to 8 wk of ANT, which might be linked to metabolic factors such as glutamine." Hack V et al. Decreased plasma glutamine level and CD4+ T cell number in response to 8 wk of anaerobic training. Am J Physiol. 1997 May; 272(5 Pt 1): E788–95. "It is well established that in vivo changes in ratios of lymphocyte phenotype subsets is altered by glucocorticoid administration. To determine whether the lymphocyte response would be further affected by strenuous exercise, since glucocorticoids are released during exercise, 14 physically fit men were randomly given placebo (P), 4 mg of dexamethasone(DEX), or 100 mg of hydrocortisone (HCO) 4 h before high-intensity treadmill running...Pre-exercise CD3 and CD4 percentages were lower, whereas CD8 and CD56 were higher with DEX and HCO as compared to P. Exercise induced a lymphocytosis after all treatments, but subsets did not change proportionally. With P, DEX, and HCO, the magnitudes of change were comparable: CD3 and CD4 decreased and CD8 and CD56 increased." Singh A et al. Lymphocyte subset responses to exercise and glucocorticoid suppression in healthy men. Med Sci Sports Exerc. 1996 Jul; 28(7): 822–8. http://davidcrowe.ca/SciHealthEnv/papers/9974-LymphocyteSubsetResponsesToExercise.pdf "Moderate exercise appears to stimulate the immune system, but there is good evidence that intense exercise can cause immune deficiency. In the present study the authors examined the effect of continuous physical exercise (35% of VO2 max), calorie deficiency and sleep deprivation on the immune system of young men participating in a 5-7 days military training course. There was a two-three fold increase of neutrophils from day 1, the values remained high and decreased slightly at the end of the course. Monocyte counts also increased with a pattern similar to that of neutrophils. Eosinophils decreased to 30% of control and lymphocyte numbers decreased by 30-40%. All the major subgroups (CD4 T cells, CD8 T cells, B cells, NK cells) were reduced...the data indicate that even a moderate physical activity, around the clock, caused significant suppression of a number of parameters reflecting the status of the specific, lymphocyte-related immunity. It is noteworthy, however, that there was no significantly increased infection rate during the course or in the first 4-5 weeks thereafter. [which makes you wonder how accurate these numbers are at measuring the health of the immune system]" Bøyum A et al. The effect of strenuous exercise, calorie deficiency and sleep deprivation on white blood cells, plasma immunoglobulins and cytokines. Scand J Immunol. 1996 Feb; 43(2): 228–35. "Eight healthy men infected with human immunodeficiency virus, type 1 (HIV) and eight HIV seronegative age- and sex-matched controls exercised on a bicycle ergometer (75% of VO2max, 1 h). The percentages of CD4+, CD4+45RA+, and CD4+45RO+ cells did not change, whereas the absolute number of CD4+ cells increased twofold during exercise and fell below pre[vious] values 2 h after...because the total number of CD4+ cells, but not the percentage of CD4+ cells, changed in response to exercise, this study further strengthens the idea that the percentage of CD4+ cells is preferable to the number of CD4+ cells in monitoring patients seropositive for HIV. [yet, 20 years later, the CD4 counts are usually used alone to monitor the ‘health’ of the immune system, only in HIV+ people]" Ullum H et al. The effect of acute exercise on lymphocyte subsets, natural killer cells, proliferative responses, and cytokines in HIV-seropositive persons. J Acquir Immune Defic Syndr. 1994 Nov; 7(11): 1122–33. "We previously reported that 2-night/3-day trips to forest parks enhanced human NK [natural killer cell] activity, the number of NK cells, and intracellular anti-cancer proteins in lymphocytes, and that this increased NK activity lasted for more than 7 days after the trip in both male and female subjects. In the present study, we investigated the effect of a day trip to a forest park on human NK activity in male subjects...The subjects experienced a day trip to a forest park in the suburbs of Tokyo. They walked for two hours in the morning and afternoon, respectively, in the forest park on Sunday...The day trip to the forest park significantly increased NK activity and the numbers of CD16(+) and CD56(+) NK cells, perforin, granulysin, and granzyme A/B-expressing NK cells and significantly decreased CD4(+) T cells, the concentrations of cortisol in the blood and adrenaline in urine." Li Q et al. A day trip to a forest park increases human natural killer activity and the expression of anti-cancer proteins in male subjects. J Biol Regul Homeost Agents. 2010 Apr-Jun; 24(2): 157–65. "Obesity modifies inflammatory mediators, but little is known about how obesity modifies the inflammatory responses of exercising children. This study assessed the acute effect of exercise on inflammatory mediators in overweight children. Twenty-eight overweight (OW) youth (body mass index > 85%) and 30 normal-weight (NW) controls of the same proportions of age and gender performed 10 2-minute bouts of cycle ergometry exercise above the anaerobic threshold, with 1-minute rest intervals between bouts…Exercise significantly decreased CD4 and CD8 cells, which remained depressed 2 hours post-exercise in the OW children.”
McMurray RG et al. Cellular immunity and inflammatory mediator responses to intense exercise in overweight children and adolescents. J Investig Med. 2007 Apr; 55(3): 120–9.

“A total of 1038 professional athletes were examined…No obvious difference was found in WBC [white blood cell] count between the athletes, all within normal range. The proportion of lymphocytes was increased in the athletes by 20%-40% in comparison with the normal level, and the CD3+, CD3+CD4+, and CD3+CD8+ T, B, and NK lymphocyte subsets were all lower in the athletes than the normal range…Long-term exercise training affects the immune system and cause stress, which may potentially increase the risks of some chronic diseases.”
Dong J et al. [Exercise-induced changes of T lymphocytes subgroups and immune factors]. Nan Fang Yi Ke Da Xue Xue Bao. 2010 Oct; 30(10): 2277–80.

“\We compared the circulating levels of T cell receptor excision circles (TREC), a marker of recent thymic emigrants, as well as the levels of naïve and memory subsets in a group of elite endurance athletes and in controls. The athletes showed a reduction in absolute numbers of naïve T cells, particularly in CD4 T cells. In contrast, memory cells were increased…Since thymic production of T cells naturally decline with age, these results raise the concern that prolonging high intensity exercise into the 4th decade of life may have deleterious consequences for athletes’ health. [listen to your doctor and stop exercising!]”
Prieto-Hinojosa A et al. Reduced thymic output in elite athletes. Brain Behav Immun. 2014 Jan 13.
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