Question
Why has my CD4 count fallen?
16 January 2024. Related: All topics, CD4 and viral load.
I was diagnosed positive 18 months ago.
CD4 = 291
After 3 months I was undetectable and CD4 = 505
After 6 months I was undetectable and CD4 = 650
Now after 18 months viral load is 170 and CD4=45
Doctor says it’s very likely a blip, but what’s really stressing me out is the drop in CD4.
I had a slight cough on the test day that has cleared up, but otherwise I felt fine.
I take my medication every morning, and have never missed a dose.
I’m quite stressed about this result.
Thank you all.
Answer
Hi, how are you doing?
I am sorry to hear you are feeling quite stressed. It is good to hear you take your medication daily and have never missed a dose.
Your viral load is still suppressed and shows your medication is still working. The most likely reason as mentioned is a blip.
You have mentioned that you had a cough on the day of testing. Being ill can appear to change these results. They can falsely elevate your viral load and lead your Cd4 count to looking lower than normal.
Have you been told what your CD4% is? This is similar to the count but unlike the count which fluctuates with other infections, time of day and exercise, the CD4% remains much more stable throughout testing.
Have you been offered a second test soon to confirm what your lab results are?
Josh.
Hi Francis, in some way each of these different values can be considered undetectable. The most important is that below 200 U=U applies. This technicality means that a viral load of 200 or less is undetectable.
A lot of clinical guidelines report that being below 50 is undetectable. In most cases this relies upon the sensitivity of the test being used. Some tests may only be able to read as low as 200 whereas others can read below 70. In these cases a viral load of 107 would be undetectable with the first test but not with the second.
Below 200 is when U=U applies meaning you cannot transmit HIV via sex and HIV is suppressed so low it is not damaging your immune system. This is why you can consider a viral load below 200 undetectable.
Good afternoon the last VL is 107 but shows detected, please are you saying less than 200 is undetectable? I have also read here that between 20-50-70 are considered to be undetected. Which of this numbers are correct.
Hi Craig, I can’t find your original post. What is your current viral load? and over how long have you noticed this change in your CD4 count?
Have you also been told your CD4%? This is a much more reliable result rather than the actual count. The count can fluctuate due to other infections/vaccines, exercise and even the time of day you take the test.
A viral load below 200 is still considered undetectable and U=U can apply. Often the difference between someone having a viral load of 199 and undetectable is how specific the viral load test is. If a test cannot read below 200 any value below will be undetectable.
Hi josh.
Apologies. I just re-read what I wrote. On my last test my cd4 count was 450 (not 45)
I’ve gone from 505-650-450 since starting medication. It is the drop, coupled with not being completely undetectable that has me worried.
Sorry for the type-o.