Question
I have peripheral neuropathy, why is my CD4 count fluctuating?
11 June 2010. Related: All topics, CD4 and viral load, Drug interactions, Side effects.
Hi guys! Thanks in advance for your great service!
Can you please tell me if a drop of CD4 from 1100 to 830 while being on treatment for two yrs and undetectable is a bad sign? I know it’s still a great count. My CD4% is 41.
I’ve developed peripheral neuropathy which has just been diagnosed but have been told there is little they can do for this. I’ve been put on Gabapentine for this.
My combination therapy is darunavir/ritonavir and Truvada. I’ve also now been put on Citalopram as things have been very difficult recently.
The HIV pharmacist says no interactions except the ritonavir can boost some levels of these other drugs. Am I worrying needlessly?
Answer
Thank you for your question.
I am sorry to hear that things have been difficult for you recently. Do you have all the support that you need? If you need to talk to someone or would like us to put you in touch with any service providers you feel would help support you then please call the Treatment Information Phoneline on 0808 800 6013 Mon-Wed 12-4pm.
Many people experience fluctuating CD4 count whether on treatment or not. There are several explanations for this which are outlined in a previous similar question. Your CD4 count and your CD4% are both very good even with this slight decrease.
I am sorry to hear that you have developed peripheral neuropathy. From your question it is not clear whether you have been on your current combination for a long time or if you have recently changed combinations as a result of the peripheral neuropathy.
The current combination you are on is not commonly associated with causing neuropathy. If you have been on this combination for a while then the neuropathy may be a result of the HIV (thought this only usually happens at very low CD4 counts), or from another health complication (in which case your doctor should be able to explain or test for this, for example, diabetes).
Once someone has neuropathy unfortunately there is little that can be done to reverse it. Gabapentine can help with the pain, but has side effects itself that affect how you feel. Some things have been known to make it worse which you should try to avoid. These include smoking, amphetamines and vitamin B12 and E deficiency. For more information about neuropathy please follow this link.
Your HIV pharmacist is correct that there are no interactions but ritonavir could boost the levels of the drugs in your system. You should speak to your HIV doctor about monitoring this over the next few months to ensure you are not taking doses which are too high.
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