Question
Why is my CD4 count fluctuating?
6 December 2023. Related: Adherence, All topics, CD4 and viral load, Changing treatment.
I was undetectable on Atripla. I was switched to Biktarvy. I fluctuated to detectable and undetectable and my CD4 count fluctuated from 240 to 346, that’s the highest it’s ever been in 10 years. Recently My Dr put me on Juluca. I am now detectable (27) and CD4 count dropped from 346 down to 244 since labs 3 months ago, that test was done before going on Juluca.
Why have I been fluctuating since being off Atripla. I have never missed my meds, I dint smoke or drink, I’m in great shape.
Any suggestions ?
Answer
Hi, how are you doing?
It is great to hear that your viral load is suppressed.
Clinically a viral load below 50 is considered undetectable. A result below 50 is negligible and only demonstrates a highly sensitive test that can pick up small amounts of HIV. A viral load of 27 is as good as any viral load below 50 and shows treatment is suppressing HIV.
As your viral load is below 200, U=U still applies and a detectable viral load of 27 is nothing to be concerned about. When you have said your viral load has become detectable in the past while on Biktarvy, how high did your viral load become?
As you have moved between different types of treatment and your viral load has remained suppressed, it shows that you do not have a resistance to any of these drug classes.
As your CD4 count fluctuated, were you ever told your CD4%? An absolute CD4 count is not always a reliable measure. This is because other infections, vaccines and even the time of day can interfere with the actual count. The CD4% is more stable and is more suitable to look at a trend over time of how your body is responding to treatment.
Before switching to Biktarvy what was your CD4 count usually? and was this CD4 count of 346 an isolated test e.g., was it repeated or did you only get this result once?
As you have returned to a stable CD4 count moving from 240 to 244 it is more suggestive that the 346 result was an error/transient rise.
Do you have a following test now that you have started Juluca? How are you finding this new treatment?
Josh.
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