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 Dance
Based on these results you need to talk to your doctor about changing to second-line treatment. This discussion should have happened when you got the CD4=110 and VL = 17,000 result. The latest results just confirm that your treatment needs to be changed. Even without a resistance test, your virus will be resistant to all the drugs in your combination. Because your CD4 count dropped back below 100 this is very important to change. Otherwise there is a high risk that you will become sick. What did your doctor say about these results? Is second-line treatment available in your country?
Hi Doctors
I tested + in 2014 and started immediately with treatment as I contracted TB. At that time my CD4 count was 45 and viral load was around 300k. then after 3 month I did my test and CD4 count was 150 and vial load undetecable. then 6 month later the test showed that CD4 Count has drop to 110 and VL up to 17000, then this August I did another test which showed that CD4 count is down to 45 and VL AT 69000. I am taking Antroiza and never defaulted. Does this means that I am going to be sick??
HIV treatment can still work even with a CD4 count of zero.
The response will be more slow but the is still good reasons to be optimistic.
He needs to start HIV treatment urgently, plus protective antibiotics – and to have his eyes checked by a specialist.
If yo meant that his viral load is undetectable, this is also a reason to start treatment but the situaion is very different. Please check thse two tests are not mixed up – which is easy to do.
A close relative of mine tested hiv positive. His cd4 count is undetectable. Can he commence hiv treatment in that condition ?what are the chances of the drugs working?
Hi Khanya – I am not a doctor but the few points might be helpful.
First, do you have access to a viral load test? Or is is just the CD4 count?
If your viral load is undetectable then your treatment is still working and the CD4 drop is not significant.
Please talk to your doctor about treatment for shingles. It is important to get aciclovir to help with the shingles recover more quickly.
This would be a good time to ask your docot about your HIV treatment.
Hi I started taking ARV’s (daily single dose) in October 2014 with Cd4 count of 146. My problem is that I’m on treating but my CD4 count keeps on dropping. 2015 Dec it was on 296 and this month its on 205. I’ve never skipped a treatment and about a month ago I had shingles in my back. Please help.
Hi Lina – CD4 counts can easily change this much without there being anything wrong. There is a large ranges that is all the same result to a doctor. This is esepcially true at CD4 counts above 500. Your results at 1100 and 900 are not showing anything is wrong or any change.
My cd4 count was 1,100 i went for cd4 test last month i did notice my cd4 decrease by 200. . From 1,100 to 900 please help me . . . . . . . . . . . . . . . . . . . . . . . . . . . . what might be d cause? ?
Hi, It sounds like the doctor has given you good advice. HIV treatment can work at any CD4 count, even when a CD4 count is low. So starting treatment quickly can help your CD4 count to recover, and this can reduce the risk of getting illnesses.
You can talk to your doctor about night sweats. It’s important that they know about these.
You can find out more information about starting treatment here:
http://i-base.info/qa/8296
Hi, I tested yesterday, I am HIV+ and my CD4 count is 49. So I’m worried because the doctor said I should come on the 9th of June to take my treatment. So I just want to know is there anything can happen to me because I’m sick and sweating every night.