Q and A

Question

My CD4 has dropped slightly, am I OK?

I found out I was HIV positive on November 3, 2019. I started treatment on November 7, 2019 with Biktarvy. I started with a viral load of 4.8 million and a CD4 of 15. The only reason I went to the doctor was due to PCP. My follow up visits have went as follows:

1st Visit: Nov 7, 2019 / CD4 15 & VL 4.8 million; CD4%- was 1%
2nd Visit: Nov 21, 2019 / CD4 44 & VL2,350 & CD4% – was 6%
3rd Visit: December 17, 2019 / CD4 82 & VL 626 & CD4% – 4%
4th Visit: Feb 17, 2020 /CD4 78 & VL 206 & CD4% – 4%

I’m 30/ don’t smoke or drink / all other labs are great regarding kidneys and liver / I do not have any other underlying health conditions.

I’ve been treating with strict adherence for a little over three months. Seeing my CD4 number really got to me down today because I was expecting it to be higher. However my VL has dropped and my CD4% is the same. My question is am I causing my self stress for no reason or should I be concerned that the CD4# dropped some instead of increasing. I can deal with having HIV what I hate is still having AIDS currently.

I know its normal for the VL to take longer to become undetectable since i started so high but I just want to see am I’m treading good?

My Questions:
1. Should I be concerned?
2. Is this a normal pattern of recovery?
3. Should I be more concerned with my cd4 increasing after I’m undetectable?

Answer

Thanks for getting in touch.

Given that you started ARVs with a very low CD4 count and a very high viral load, you’re doing amazingly well. Your viral load is near enough undetectable and I suspect that by the time you have your next test it will be undetectable, this is great news.

When someone starts medication, it’s important to understand that it takes time for a CD4 count to rise, more so when you start with a very low CD4 count. Though you CD4 may have gone from 82 to 78, this isn’t really something to be concerned about, the reason being is that CD4s change during the course of the day. Also as your viral load is coming down, this means that the medication is working.

In response to your specific questions:

1. Should I be concerned? No, you’re doing great.
2. Is this a normal pattern of recovery? Yes this is a common pattern.
3. Should I be more concerned with my cd4 increasing after I’m undetectable? Not really, as in time it will rise. The important thing is to ensure that you adhere to your medication.

One last thing, try not to think of this as AIDS. You have HIV and you’re taking control.

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