Question
Why does my CD4 count vary on treatment? Can I do anything to keep it higher?
29 May 2007. Related: All topics, CD4 and viral load.
On my last lab results, my CD4 count had dropped from 350 cells/mm3 to 200 cells/mm3.
l take my medication religiously and never missed a dose, although at times l delay about an hour to 30mins from the usual time l take my meds.
Anyway my question is ‘why does the CD4 count fluctuate like this when on meds and what is a bleep/blip?
What can l do differently to maintain a good CD count?
l view myself as lucky and healthy as l have never suffered any side effects with my combination of abacavir/3TC (Kivexa) and atazanavir/ritonavir (Reyataz, boosted by Norvir) all taken once daily.
Answer
Hi
Thanks for posting your question and allowing us to answer online.
The first thing is that CD4 counts can fluctuate whether or not you are on treatment. This can relate to time of day, what you have last eaten and whether you have been resting or taking exercise. All these fluctuations do not reflect any real change in your immune system.
Although it is disconcerting if your CD4 count goes down on treatment, it may not be a real result. Ask whether your CD4 percentage has changed – if not, then there is no real difference in the actual count.
If your CD4 percentage has also changed, and their is no other explanation for the drop (ie a recent cold) ask to have the tests repeated. If the count continues to drop, even if your viral load is undetectable, you may want to talk about trying another combination.
A small percentage of people (perhaps 5-10%) have ‘discordant’ lab results. ie their CD4 count falls with an undetectable viral load, or their CD4 count rises while their viral load is still going up. Of these, the former is more serious because it increases your risk of infections.
A ‘blip’ relates to a change in viral load results which were steadily undetectable (less than 50 copies/mL) and then tested as anything from 51 to around several hundred copies/mL, but which went back undetectable with the confirmatory test.
Blips can sometimes go as high as 2000 copies/mL, so the confirmatory test is essential before making any change in treatment.
Although everyone processes drugs differently, a window period of 30-60 minutes for the combination you are using should not have had any effect on your risk of treatment failing, or in this drop in your CD4 count. If it is longer than than an hour, and on a regular basis, your levels of drugs may become too low.
There is not much you can to to directly affect your CD4 count, other than using HIV drugs. Cutting out stress is likely to help.
Several other posts have asked about this.
Hi Syah, you have a great viral load. It shows that your treatment is working and is suppressing HIV. How long have you been on treatment?
If the last result is that they couldn’t detect your viral load this is a good thing. It means that your viral load is so low tests can’t pick it up. This shows that your treatment is working as well as it can.
When this is the case it will allow your CD4 cells to naturally recover. This can be a slow process. The lower your CD4 count to start before treatment, the longer recovery is. Are you on an anti-biotic called co-trimoxazole? Having a CD4 count below 350 can put you at risk of some other infections, so this medication is used to prevent other infections as you recover.
Hi. The doctor didnt tell me about my cd4%. They just run ctscan i think to see if i have any other health problem. My last viral load is 219 but they didnt tell me about the new one because the doctor said my cd4 is still okay and they cant or didnt detect my viral load or maybe the blood test is only to know my cd4. I dont really understand what the doctor said
Hi Syah, have you been told what your CD4% is? CD4 count is not always reliable as it is prone to looking like it is fluctuating.
Other infections/vaccines, the time of day and exercise can all change what your CD4 count is on the day of testing.
Do you know what your viral load is?
As you have only recently started treatment this is not likely something to be worried about. Have you been offered another CD4 test? and what did your doctor tell you about these results?
Hi. I just got my blood test result. My cd4 dropped from from 258 to 136. And im on medication. Before medication my cd4 is 156 then after two months of medication it rised to 258 then dropped back. Should i be worry ?
Hello, my viral load keeps jumping every 3 months within 300-320 up and down, varying every 3 months that I get my lab work done. Although I am undetectable, this concerns me. I’m wondering if it could be the change in my meds that took place the beginning of this year that it causing it to go up and down. I actually had jumped up to 1276 and now am back down to 945, that seems like a drastic change to me.
Hi Viki,
Everyone’s CD4 count goes up and down. Please see this Q&A here.
On average, the normal CD4 range for an HIV negative person is between 460 and 1600. This is an average. Anywhere in this range is good. For more on CD4 counts please see this link.
Being undetectable is a good predictor of better health. As you’re undetectable your new meds look like they’re working just as well. And your CD4 count is strong.