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 Demiji,
Are you on medication? If you are how long have you been on it for? What was your CD4 when you were diagnosed?
My recent shows my cd4 count is 349
.what does that mean
Hi Tebogo,
As you can see from the answer above, CD4 counts can go up or down for different reasons.
It’s good that you’re undetectable. That shows Trivenz is working against HIV. Do you have access to your results? The CD4 percentage can be a better guide to the strength of your immune system. Please see this link for more info about CD4 results.
Hi my viral load is undetectable while my cd4 count dropped to 200 is that normal I’m on trivenz and I have being taking arvs for 5 yrs now
Hi Rolinnes, the are lots of couples where one partner is positive and the other is negative. This usually involves a lot of talking first :)
When the positive partner is not on treatment it is just important to use condoms. After starting effective HIV treatment, the risk of transmission gets close to zero. This is so low than many couples conceive naturually to have a family, without HIV passing to the partner or children.
http://i-base.info/guides/pregnancy/what-to-do-when-one-partner-is-hiv-positive-and-the-other-is-hiv-negative
Can a man with hiv marry someone which is hiv negative without affecting her?
Hi m s – what are the recent CD4 counts that you are worried about? How much has this changed over what time?
Having an undetectable viral load is more important. Most CD4 differences are normal fluctuations of the test.
I am bit concerned as the viral load is undetectable but cd4 keeps dropping. should I be concerned or what can I eat to increase the cd4
Hi, You don’t say what your previous CD4 count is. CD4 counts can go up and down. And a viral load of 600 could be just a blip. A blip is where HIV becomes detectable for just one test and then goes undetectable for the next.
But it’s important to keep your viral load undetectable. This can also help stop your CD4 count from falling.
Talk to your doctor about your HIV treatment to make sure it’s working, and discuss what’s worrying you.
Hi, My VL 600 and my latest test revealed it to be 326. I feel a bit worried. Should I be concerned? Thanks.