Q and A

Question

My CD4 count seems to be dropping. What can I do?

I tested positive in February 2010. My viral load was 10,000 and CD4 count was 231, two weeks later my viral load was 12,000 and CD4 count was 224. The readings were the same at the end of March.

I started on Atripla in April. Reading from the end of April was inconclusive as the blood sample wasn’t handled correctly. In July viral load was undetectable and CD4 count of 265. Results in November, from my most recent blood sample was that viral load was undetectable but CD4 count was 229, down below my very first reading.

Is there a reason my CD4 count would decrease? My doctor wasn’t overly concerned saying that it takes longer for the CD4 count to rise when starting from a low number but I am concerned. A slow rise in CD4 count would be one thing but a regression seems more serious to me.

I don’t drink alcohol, smoke or take drugs, have a good balanced diet and take regular exercise. I feel well and haven’t been sick since starting the treatment. Might my CD4 count stay permanently low or could it continue to decrease, even if my viral load stays undetectable? Is there anything I should try to do to try to boost my CD4 count? What might be the implications of a permanently low CD4 count even if my viral load remains undetectable? Apologies for the long-winded question and many thanks for your help.

Answer

Thank you for your question.

Please do not worry. It is normal for CD4 counts to fluctuate. Although your CD4 count appears to be decreasing the differences are very small between the figures and could be seen as remaining quite stable. The slight fluctuation could be as a result of many things including the time of day you tested, how much exercise you did before the test, how tired/stressed you are etc.

For more information about fluctuating CD4 counts please follow this link

Your doctor is correct that your CD4 count will take longer to increase once you have started treatment. Some people can take over a year on treatment before their CD4 count starts to increase.

Unfortunately there is little you can do to increase your CD4 count aside from taking ARVs. When you are on treatment the most important thing to monitor is your viral load which, now that you are on treatment, should remain undetectable.

48 comments

  1. Lisa Thorley

    Hi PP,

    Because your viral load is undetectable, this means that the medication is working. This is a good thing. With regards to your CD4 count, you were diagnosed with a very low CD4 count. Though its still low, it has risen. It’s very possible that it’s just going to take some time for it to rise. Have you talked to your doctor about this?

  2. Pp

    I started my treatment with only CD4count of 3 and IV been on treatment for a year and 3months,maybe I skipped not more than 2times since I started,Now my Viral load is undetectable and my CD4count is 33, should I worry?

    I never got sick since started the treatment.

  3. Lisa Thorley

    Hi Thubelihle,

    What was your CD4 count when you were diagnosed with HIV? What is your CD4 count history? How long have you been on treatment for?

  4. Thubelihle

    I presume the cd4 count has a significant element that it plays. I am concerned as I have low cd4 count of 207 and undectactable viral load. Does this signify that I will be valnarable to some diseases and possibley die? I have never consumed alcohol or drugs or smoke in my entire life. Except that I have unemployment stress of having the credentials and extensive expertise in my working experience but cannot find employment. I am seriously concerned please advise, what are the repecussions of this and what is the fundament aspect towards the lowering of the cd4 count as its seemingly supposed to fluctuate. Thus fluctuation, simply means going an upward trend as well. So why is it solely undertaking an downward trend with a significant amount of 207 remaining. Please advise the adverse effects and the possible implications behind this lowering of my cd4 count. What are turnaround strategies towards attianing this pit fall which I encountered as I am so concerned of the predicament. Please revert to me and I would be obliged if that could be a prompt response. Thank you.

  5. Roy Trevelion

    Hi Hlengiwe,
    It’s great that your viral load is fine. But stress and anxiety can have an effect on your CD4 count. It sounds like your doctor’s advice is sensible. Keeping viral load undetectable is the way to help build your CD4 count. Can your doctor help with your stress levels? Getting support while you go through a stressful time can be important for your health.

  6. Hlengiwe

    I never had problems of a dropping CD4 count until 2016. Before having stress it was always increasing and viral load fine. Even today viral load is fine, only CD4 which worries me even though my doctor said there’s nothing to worry, and it’s normal fluntuating of CD4 when you are under pressure but I’m asking for something to boost it. Will be taking another blood test next year in February.

  7. Lisa Thorley

    Hi Mable,

    Has your viral load ever been undetectable? If it has when was this? There is a possibility that the change in CD4 is a blip, however this should be tested again. If it is going down and your viral load is rising then there may be a problem with your medication.

  8. Mable

    I’m positive and on meds. My CD4 was 344 but now its 121,viral load on 171. I was adviced to test for TB and it was negative. What should I do?

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