Question
My CD4 has dropped, but my viral load is undetectable, is this OK?
7 November 2017. Related: All topics, CD4 and viral load.
HI I was recently diagnosed HIV positive and discovered PCP lung infections as well. I started HIV medication immediately.
I made good progress and within six weeks VL came down to 160 – originally was detected around 3900. My CD4 improved from 96 to 206. My PCPalso got much better my cough gone. My concern is now after two month checks my VL is 23 BUT my CD4 count dropped to 115 from progressing piont.
I am contining with medication very carefully. Please guide me about the CD4 fall as I expected with low viral load to 23 that my CD4 level should rise more. My understanding is that the CD level actually help to make immune system stronger. Or its not any issues as long as my viral load goes to undetectable level.
Many thanks
Answer
Thanks for getting in touch.
CD4’s can and do fluctuate, as the following link discusses:
If your viral load was detectable then this may be something to worry about. However, as its undetectable it means that the meds are working, and working well.
Because you’re in the UK you could ask to have your CD4 count retested.
Also, your doctor will still need to prescribe antibiotics called cotrimoxazole until your CD4 count is stable at a higher level. This is for the PCP and other infections.
Hi Jose, thanks for these detailed results. One detail about your viral load result sis the undetectable should be <20 rather than >20 but this might be a type which is easy to mix up.
My first question is to ask what your doctor says about these results? The results are still all good and this might just be natural variability. Although the CD4% and ration are less the the normal range, this is very common if your CD4 count was lowere when you started treatment.
Vaccines can easily affect your CD4 count though – and someteims viral load – so the next results might show a higher CD4 count again.
This is good to monitor though.
Hello,
7/2024
CD4 691 cel/mm³
8/2025:
CD4 absoluto: 590 cel/mm³ (rango normal: 404-1612)
CD4 porcentaje: 28.6% (rango normal: 33-58%) ⚠️
Relación CD4/CD8: 0.58 (rango normal: 0.8-4.2) ⚠️
11/2025:
CD4 absoluto: 395 cel/mm³ (rango normal: 404-1612) ⚠️
CD4 porcentaje: 25.1% (rango normal: 33-58%) ⚠️
Relación CD4/CD8: 0.45 (rango normal: 0.8-4.2)
VL >20 always
ARV Genvoya
Adherence 100%
CD4 are going down.
based on your experience Should I be worried?
I had the flu during my last exam. Could this have affected things?
Thanks a Lot
Jose.