Question
How quickly does CD4 drop after being positive?
23 July 2022. Related: All topics, CD4 and viral load, Newly diagnosed.
HIV rapid progression question:
I got a positive test Feb 2022. My previous negative test was in Jan 2020 and I also tested negative in Oct 2019. They were full blood tests in an STD clinic not rapid tests so I believe they are highly accurate. I assumed I caught HIV in May 2021 as I had an exposure with a person who has since confirmed that he is also positive. Also I became very unwell at the end of May 2021 with seroconversion symptoms.
When my CD4 count was checked in March this year it was 57 and 7%. The doctor told me that such a low a CD4 count means I’ve been positive for a long time – as long as 10 years. Meanwhile I’ve been on ART since March and my viral load is almost undetectable now (last VL count was 43). My CD4 count recovered initially to 173/12% in early May but the latest count was 131/13%. Have you ever seen a case with such a rapid deterioration in CD4 count?
If I’m correct about May 2021 it means my CD4 dropped to 57 in 10 months. Or even if I caught HIV soon after my negative test in Jan 2020 it means my CD4 count got depleted in just 2 years. Thanks
Answer
Hi, how are you doing?
The speed of how quickly CD4 count drops depends on a number of things. The biggest factors are often the strain of HIV and your own immune system.
It is not uncommon for people to have the CD4 counts drop so quickly. Up to 25% can have. their CD4 count fall below 200 in just 2 years after transmission. In this case you are part of this 25%. This is explained further here. This is termed fast progression.
Others, on the opposite extreme can take 10 years before their CD4 count falls below 200. There is no way of knowing what determines how each person will respond to HIV. Though a more significant seroconversion period does indicate that CD4 count will fall quicker.
It is great that your treatment is working. A viral load of 43 is excellent and means you cannot pass on HIV via sex. Below 200 is considered undetectable for U=U to apply. The important number in your recent CD4 tests is the percentage which has gone up. The actual count can fluctuate between tests because of other factors inc. time of day, recent infection and exercise.
How often are you getting your CD4 count checked? CD4% is a better marker for how CD4 count is recovering and your medication suppressing HIV.
Josh.
Hello Alex and thanks for getting in touch.
Please note: we are not doctors, we are treatment activists.
A high viral load of 600.000 copies/ml is more than sufficient to explain your drop in CD4 count.
A high viral load, usually seen at the beginning of infection (you are right about that), in the acute phase, is the main reason the CD4 count drops.
Everyone is different though so we can’t really say how long it takes to go from a point A to point B, as everyone of us will need a different amount of time.
Here you can read more about the CD4 count:
https://i-base.info/qa/cd4-faqs
How are you coping with your diagnosis?
Here are some information for people who just found out they are living with HIV, which I think you will find useful:
https://i-base.info/just-found-out/
Hi Doctor,
I find myself in a similar situation. I believe I became infected mid October 2024 and tested positive in early December after having seroconversion symptoms and a false negative in mid november (which was surely during the window period). Before that i had always tested negative as I took a test every three months. The first analysis right before starting treatment showed a CD4 count of 374, and a viral load of 600,000 (the latter is common during the acute phase, right?). Is it possible for CD4 count to drop so fast in acute cases? It would mean my CD4 count dropped below 400 in less than 2 months. Could that be more an indication of an error in the analysis or the product of another preexisting condition, or is this situation possible?
Best regards
Hello Carla
Please contact us at questions@i-base.org.uk if you want to discuss privately.
I wan to discuss
Hi Daku, you do not have HIV. Your test results are conclusive and you do not require any further tests for HIV.
For more information about testing and transmission please see here: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hello sir.
I am vary scared and going depression
Dear josh sir
I had a risky exposure on 16th april 2023 i was tested every time negative after 3 month negative cd4 1250/1600, 5 month negative cd4 1247/1600
After 8 month i had herpes zoster in my ear cd4 2000/1600 after 9 month February rna pcr qualitative test target not detected cd4 850/1600
Dear sir i have little bit headache in morning and all day ok
Please help me if u can
Hi Phillip, it is great to hear that you are doing well on ART. I am glad taht your CD4 count is going in the right direction. This increase in viral load is not significant. There are a number of factors that can change the number inc. random temporary increases. Only going up a few numbers does not give rise for concern.
It is good that you are on Seprin, though usually it is given on the basis of CD4 count and not viral load. This is because the antibiotic helps to prevent infection while your CD4 count recovers and your immune system is not as effective as it could be. This often depends on the country you are in e.g., in some the cut off for stopping may be 200 and above, while in others it can be as high as 350 and above.
I am glad that you are getting support. Not feeling ready to tell people about your status is absolutely okay. Don’t feel like this needs to be a rushed process. Sounds like your doctors are giving you excellent support as you adjust to being HIV positive.
Hi Josh,
I got better news on my CD4 result from Jul 19th – it was up to 208 and 14%. My viral load, however, also increased to 68 (in June it was 43 and in May it was less than 40).
Not sure how significant that increase is. My adherence has been 100% since Mar when I started ART.
Regarding your question on other medication, I am taking one Septerin pill per day since Mar 15th. The doctor said that needs to continue until I have 3 consecutive months undetectable.
I haven’t told anyone about my diagnosis – I don’t feel ready to do that.
I get support from following i-base website and also the doctors in the clinic I attend are supportive and non-judgemental.
Thanks for the great work that you and your colleagues do on this site.
Hi Philip, while your CD4 count does appear to have stopped increasing, it is encouraging that your percentage has continued to increase. Starting at lower CD4 counts means the time taken for recovery can be much longer. How quickly your body has responded to medication and your viral load being suppressed so soon is very good.
While your CD4 count is low, have you been given any other medication? This is usually co-trimoxazole and is an antibiotic. It is a medication used to prevent infections that you are at risk of while your immune system is working less well.
I am sorry to hear that this was a massive shock to you. Have you anyone that you can speak to about this? Friends, family, your doctor?
Hi Josh,
Many thanks for your detailed response and reassuring comment re CD4 %.
If 25% of cases progress rapidly I must be one of them and I did have severe seroconversion symptoms and dramatic weight loss.
Regarding the HIV strain I’ve been told it’s HIV1.
I’ve also read about a Netherlands variant which progresses quickly but the clinic I attend say they don’t test for variants.
Luckily I have access to good medical care for free and until I achieve undetectable for 3 consecutive months I get checked every month.
My numbers to date have been:
15th Mar CD4 57 7% / VL 53952
5th Apr CD4 92 10% / VL 515
3rd May CD4 173 12% / VL 100
31st May CD4 155 11% / VL <40
21st Jun CD4 131 13% / VL 43
So after initial encouraging CD4 recovery it seems to have flatlined since May.
Hopefully it will start to trend up again with good adherence. The diagnosis came as a massive shock and I've been so worried since it happened. Best regards