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 – I will send you an email about this :)
Hi, I found out I was HIV+ in 2012 and my CD4 count was 49. I was put on treatment by my doctor on Atripla and I was using it till last May (2013), then I switched to Atrioza because of the price. My CD4 has been going up gradually over the past 18 months to 269 in March this year. In August my CD4 count has dropped to 234 but my viral load is undetectable. My question is should I be worried because of the drop in my cd4 count, and the fact that i started with Atripla and now the generic (Atroiza) is not as effective as Atripla. I gained too much weight for the past two years I don’t know how to control it anymore. Please assist.
I’ll be glad if you could reply on my email address.
Hi,
I’m sorry to hear about your diagnosis. It is normal for your CD4 count to decrease before you start treatment. In the UK guidelines don’t recommend starting treatment until your CD4 count has reached 350. This is because starting treatment earlier has not been shown to have any greater long term health benefits.
You can find information about being newly diagnosed here:
http://i-base.info/if-you-have-just-found-out-you-are-hiv-positive/
And information about starting treatment here:
http://i-base.info/guides/starting
I recently found out that I’m positive and my CD4 was 530 and. I got tested again and it was down as 450 now I did test again its 398 and I’m not yet on treatment. Why its decreasing like this ? I’m worried that I might get sick.
Hi Menzi,
I’m sorry to hear about your recent diagnosis. Do you have any support to help you deal with this? To find out about support in South Africa you could contact the Treatment Action Campaign.
The only way to increase your CD4 count and lower your risk of getting ill is to take HIV treatment called antiretrovirals (ARVs). Because your CD4 count is under 200 you are at risk of infections like TB and pneumonia so it is important that you start treatment soon. Have you discussed starting ARVs with your doctor? Please follow this link for more information about CD4 counts and starting treatment.
hi i am 25 year old and recently found i am HIV Positive and my cd4 count its 150. i am very worried scared to get sick, how do i get healthy and increase my cd4 count. i stopped drinking and smoking since i got my results
Hi Mema,
Dual infection with HIV-1 and HIV-2 can be effectively treated, but does require different drugs to single HIV-1 infection. If your mum does have both viruses she will need to change her treatment, because NNRTIs (like efavirenz) are not effective at treating dual infection. The British HIV Association (BHIVA) guidelines would recommend changing efavirenz to either lopinavir/ritonavir or darunavir/ritonavir. But this is something she needs to discuss with her doctor. You can access the BHIVA guidelines for HIV-2 infection on their website which may be useful in speaking with her doctor.
hi, Mum did a confirmatory test which has revealed that she has both HIV type 1 and type 2. The re-do test shows that she has 592 as CD4. This no doubt is a better cd4 count but still steady decline is apparent from 800 cells. So now the question is with these two types of HIV present, should she still continue taking the same medication of AZT,3TC and efivirence or is there any need to change the medication due to the mixed infection? If so what options would you recommend? Eargerly waiting for your response. MEMA
Hi Mema,
Let me know what the results are of the confirmatory test. Until you have these results there’s no point worrying, because you don’t know if her CD4 count really has dropped so far. ARVs are the only way to increase CD4 counts, but eating a healthy diet and making sure she tells her doctor if she is feeling unwell are both important.
Thank’s alot for your encouraging advise. I’ll have her repeat the CD4 count and if the results are the same we’ll discuss with the doctor about the possibility of changing the medication. The reason why am panicking is that in less than two years she has lost half of the CD4 cells she had. Therefore what will she remain with in the coming year.Its just that third line treatment drugs are not readily available where we are and so that’s why am so worried. I am just looking for any alternative which can quickly boost her CD4 count to reduce the risk of her contracting opportunistic infections.