Q and A

Question

Should I worry about this drop in my CD4% and CD4?

I was diagnosed HIV+ on July 2019 with CD4 count of 80, CD4% of 6 and a viral load over 10 million copies. I started HIV treatment immediately with Truvada and Tivicay (tenofovir/emtricitabine and dolutegravir) and also a prophylaxis.

By January 2020, my CD4 percentage was 19% and count was 400 and a viral load less than 40 copies. Everything was ok. There were no side effects of the ARV’s and I was doing well.

Notw It has been a year on treatment and I’ve finished 13 boxes of ARV’s. Last week I went to doctor to see how is my treatment going and my late results are CD4%15 and count 250, and my viral load is 72. :(

I’m not happy with these results. I am feeling well, eating healthy, doing sports etc. I was expenting to be undetectable with about %20-25 percentage by now. Should I be worried?

I am using immune boosters such as vitamin C tablets and Umca solution. I don’t think they interact with my drugs and there is about 7 hours between I take them. I rarely drink alcohol.

What could be the problem? Should I be worried? Will I be okay? Should we change treatment?

Thanks for this platform and your help.

Answer

Hi

Thanks for your question and for letting us post an answer online.

You were really lucky to be diagnosed before you became more seriously ill. It was important that you started meds when you did. You are using a good combination and have had a great response to HIV treatment (ART). These are all really good results, including from the last tests.

Great that you are doing other important things like eating well and keeping physically active.

Before starting ART, your CD4 results were more important than viral load. Now you are on ART, the viral load results are more important.

Although your latest viral load was 70 this could easily be a blip and your real result could still be undetectable (less than 50). In the UK, the doctor would check whether you are missing any of your meds and that there are no drug interactions. Then viral load would be test again in four weeks, just to check everything is okay.

Because viral load is still so low, your meds are still all working very well. This means that your CD4 changes are nothing to worry about.

Your CD4 count varies during the day and is different depending on whether you have just eaten or taken exercise etc.

It is easy to get worried when the fluctuation goes down rather than up, but your results all sound fine.

Please ask for the viral load to be tested again though in a few weeks. Even when viral load testing in some countries is only tested once a year, this should also be done if there is a concern that viral load might be rebounding.

This link has more info:

Interpreting CD4 results: CD4 count and CD4 percentage

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