Question
Can switching to Atripla from Sustiva + Truvada explain a drop in my CD4 count?
11 June 2007. Related: All topics, CD4 and viral load, Changing treatment.
I was diagnosed in 2006 and started taking Sustiva and Truvada but recently made the transition to Atripla.
My CD4 count had been increasing steadily but my last results show a decrease in my CD4 count. My doctor tells me I have no reason to worry because I am still undetectable. My question is shouldn’t my CD4 count keep going up?
Could it be the recent change to Atripla that made my CD4 count decrease?
Answer
As Atripla contains the same doses of Sustiva and Truvada (tenofovir+FTC), there is no mechanism for why this would affect your CD4 count.
CD4 counts often fluctuate – but the trend is always more important than your last individual count.
Although on average they continue to rise on treatment, is is common for some counts to be lower than others.
If you send me your last 4-6 sets of results with the date (approximate month and year) I can give a better response. It is difficult to know whether the decrease is important without knowing the actual figures.
However, it sounds like your doctor is giving you good advice, and your next count could easily be back on track.
Viral load and CD4 counts can fluctuate. It is important not just to look at your last result but to see the trend in results over a period of 6 months or more. You should talk to your doctor about taking subsequent tests 2-3 weeks after you got this result to see if it is a viral load ‘blip’, lab error or an underlying infections which are causing the changes to your CD4 count and viral load.
For a year was on Stocrin (efavirenz) and Truvada as separate tablets and had an undectable viral load and a CD4 count of over 650 for the entire year. 3 months ago I started taking atripla and I just got the results, my viral load is up to 190 and CD4 down to 500. Why the big change and what is going on if it is meant to be the same dose but just in one convenient pill?
Thank you for your question. The most important thing when you are on treatment is that your viral load is undetectable and remains so. The slight decrease in your CD4 count could be explained by many things including the time of day you take the CD4 count test, lab error, how much sleep you had the night before etc. A CD4 count of 725 is still very good and nothing to be scared about.
Hi all,
I started Atripla recently (January 2010) my viral load was undetectabel before I started it and my CD4 ranged between 915-980, with 31% ratio. I just got back results today and my viral load was undetectable but my CD4 dropped to 725 with 28% ratio. Are they sure Atripla is doing us good?
My doctor states that I might have been unwell, hence the drop, but I am fit as a fiddle and not stressed until today that is. Can someone help? I dont want to get sick and I’m scared!