Question

Can viral load and CD4 count go up together?

19 May 2023. Related: Adherence, All topics, CD4 and viral load.

I have been living with HIV for 22 years, started treatment in 2007, maintained undetectable viral load till recently, August 2022 VL was 119 and CD4 was 440.

Now in April 2023 VL is 631 and CD4 is 568. I’m a bit confused, can the viral load and CD4 go up simultaneously? I’m a bit worried with viral load spike. I’m on (tenofovir, lamivudine and efavirenz).

Answer

Answer: Josh Peasegood

Hi, how are you doing?

As you have been undetectable and adherent with your medication, the most likely cause for these results are a lab error. Are you able to return to have a second test to confirm the results?

It is good that your CD4 has increased though as you have suggested, it would be uncommon for CD4 count and viral load to increase together.

Do you know if your CD4% was tested also? This would give a more accurate result of your actual CD4 count. CD4 count can fluctuate and not always give an accurate result. It can be affected by exercise or the time of day the test is done.

Low level viral load increases can happen randomly where viral load temporarily increases and before the next test it will return to normal. It is possible to have a blip alongside an increase in CD4 count as there would be no time HIV to damage CD4 cells. Blips however usually stay at less than 200 copies/mL.

A temporary increase in viral load can also be caused by recent infections/vaccines. In these cases the additional strain on the body leads to the viral load increasing but after the vaccine/infection clears, the viral load returns to normal.

Please ask your doctor to check viral load again in a month. If it is still detectable, you might need to change treatment.

Josh.