Question
My CD4 count seems to be dropping. What can I do?
5 November 2010. Related: All topics, CD4 and viral load, Starting treatment.
I tested positive in February 2010. My viral load was 10,000 and CD4 count was 231, two weeks later my viral load was 12,000 and CD4 count was 224. The readings were the same at the end of March.
I started on Atripla in April. Reading from the end of April was inconclusive as the blood sample wasn’t handled correctly. In July viral load was undetectable and CD4 count of 265. Results in November, from my most recent blood sample was that viral load was undetectable but CD4 count was 229, down below my very first reading.
Is there a reason my CD4 count would decrease? My doctor wasn’t overly concerned saying that it takes longer for the CD4 count to rise when starting from a low number but I am concerned. A slow rise in CD4 count would be one thing but a regression seems more serious to me.
I don’t drink alcohol, smoke or take drugs, have a good balanced diet and take regular exercise. I feel well and haven’t been sick since starting the treatment. Might my CD4 count stay permanently low or could it continue to decrease, even if my viral load stays undetectable? Is there anything I should try to do to try to boost my CD4 count? What might be the implications of a permanently low CD4 count even if my viral load remains undetectable? Apologies for the long-winded question and many thanks for your help.
Answer
Thank you for your question.
Please do not worry. It is normal for CD4 counts to fluctuate. Although your CD4 count appears to be decreasing the differences are very small between the figures and could be seen as remaining quite stable. The slight fluctuation could be as a result of many things including the time of day you tested, how much exercise you did before the test, how tired/stressed you are etc.
For more information about fluctuating CD4 counts please follow this link
Your doctor is correct that your CD4 count will take longer to increase once you have started treatment. Some people can take over a year on treatment before their CD4 count starts to increase.
Unfortunately there is little you can do to increase your CD4 count aside from taking ARVs. When you are on treatment the most important thing to monitor is your viral load which, now that you are on treatment, should remain undetectable.
Hi Mema,
If your mother’s CD4 count has dropped suddenly it is important to check this test result. This is to rule out any test error or mix up.
If your mother’s treatment had ‘failed’ you would expect her viral load to become detectable. If her CD4 count is decreasing, and continues to do so, then she may benefit from changing her treatment. A CD4 count of 335 is still strong though so try not to panic, but do make sure that her doctor looks into this.
My mother has been HIV positive since 1986. In 2000 her CD4 count dropped to 15 and increased when she commenced ART. By 2010 her CD4 had risen to 820 with undetectable viral load levels. She has been on Combivir (AZT+3TC) and Stocrin (efavirenz) since 2000. Suddenly her CD4 has drastically dropped from 820 to 335 as of December 2012. It has been declining since 2010. She has been faithfully taking her medication and has sustained the undetectable level. What should we do am really worried. Does this indicate that the medicine has now failed? What is next for her? How do we handle this situation?
Hi Vannesa,
I’m very sorry to hear about your sister. HIV treatment is very effective and should help people to live longer with HIV but unfortunately there are still people who don’t make it.
How are your aunt and her daughter doing- are they healthy?
Adult CD4 counts should increase on treatment. If your aunt has only been on treatment for 6 months her CD4 count might not have started to increase yet but her viral load should be undetectable. Does she have access to viral load testing? And do you know what her CD4 count is?
Children under 12 are usually monitored using CD4 percentage, instead of CD4 counts. This is because children’s CD4 counts drop naturally over time. There’s information about this in our training guide.
Please follow this link for information about diet and exercise. These are both important but the most important thing for both your aunt and her daughter is effective treatment.
my sis jst recently died of HIV and my aunt is also positive with her child. she just toldme her CD4 is decreasing, im not only worried but scared she might die because my sis was sick for only 2 months. my uant is on ARV for about 6 months now then her child for 7 years. what can we do as a family to help her increase her CD4 count and viral load to reduce? what kind of food does she need to eat? how often should she exercise?
Hi Clemy,
CD4 counts for you children are usually much higher than for adult. They are also usually much less constant. And as a child gets older their CD4 will naturally go down from several thousand to a few hundred. This is the same in HIV positive children and HIV negative children. For this reason children with HIV are usually monitored using the CD4 percentage. This is a more stable measure which compares what percentage of all the different immune cells are CD4 cells. Because a child’s absolute CD4 count is not easy to interpret the CD4 % is an easier way to check the strength of their immune system.
Because of this I can’t say whether this CD4 decrease is drastic, or even if it’s significant. What did your HIV consultant say about this? It would be useful to know if your daughter’s CD4 percentage has been recorded, and to see if this has also changed.
I hope this help puts your mind at ease. The CHIVA website has lots of information about HIV and children. This includes a special section for parents with advice about many of the issues to do with raising a positive child.
My child is 3 years old and is HIV posititaken the tesve. she was diagnosed with HIV when she was only 9 months old. The peaditrician recommended that she be placed on immediate ARV tratement. Her health has been good and she has been behaving like a normal 2/3 year old would be. She was due for tests in May 2012, went and taken the tests. I received the results from the lab and my meical aid HIV management consultants informed me that her CD4 count has dropped from 2534 in November 2011 to 635 in May 2012. The viral load is however UNDETECTABLE.
What does this mean that her CD4 count has dropped drasticly and what caused it to drop so much in 6 months?
What is it that I can do as a parent to help boost the health and immune system?
Worried parent!!!!
Hi Craig,
I’m not familiar with starter packs of ARVs. Can you tell me if you are HIV positive or if you are using ARVs to prevent infection?
How does the starter pack for ARV work.
There are no over the counter drugs which will increase your CD4 count. When you start taking HIV treatment your CD4 count should increase although in some people it can take a little while before they start to see an increase. For a more in-depth answer lease follow this link to a similar question.
Which medicine can I buy from the counter to increase my CD4 count?