Question
Why do CD4 counts sometimes not return to normal levels?
28 February 2012. Related: All topics, CD4 and viral load, Starting treatment.
When lucky enough to reach an undetectable level why cant your immune system repair itself bringing the CD4 count replenishing levels back to as before contracting HIV, if there is no longer any attack being made by the virus?
A lot of people submitting posts on this site appear to have reported massive increases from very low starting counts after antiretroviral treatment,
Thanks for a great site.
Answer
Thank you very much for your question.
As you didn’t include details of your own CD4 count I will answer in general terms.
So for most people the first goal is to get an undetectable viral load (less than 50 copiesmL). After this, the CD4 count usually increases, but sometimes the increase can take more time. The lower your CD4 count when you start treatment, the longer it will take to increase.
Some people who start with the lowest CD4 counts (under 100) will find it difficult to get to levels that are called ‘normal’. A ‘normal’ level is usually quoted as a CD4 count of 500.
However, so long as the CD4 count increases steadily, and especially once it is back higher than 200, the risk of HIV related complications in the futures is greatly reduced.
For a few people, the CD4 response is different. Sometimes the increase is very small and in a few people, even with undetectable viral load, CD4 count can even decline.
Why this happens is not understood. It might be that the person is unlucky. In a few people, HIV damages the immune system before treatment in ways that are not able to be repaired.
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