Question
Why has my CD4 count dropped when I am on treatment?
26 May 2011. Related: All topics, CD4 and viral load.
Hi
I’ve been taking Atripla for 1 year now. I started my medication 3 years after been infected as my CD4 was 349 at the time. I got my bloodwork results today. My CD4 is the lowest it has ever been at 239 and my viral load is undetectable. When I experienced seroconversion a couple of weeks after being infected, I felt as though I was slipping away, it was horrific. I have heard that some people can go for years without with medication their CD4 becoming low and their viral load becoming high. Some people haven’t experienced seroconversion, well, at least not as signifigant as I suffered. Fortunately, I have not been ill since apart from a cold and other normal stuff. I’ve heard that there is a type 1 and type 2 strain of HIV. Do you think that I have a more agressive strain of HIV?
Also, if my CD4 is 239, should I be concerned? Should I expect to get ill soon?
Many thanks
Answer
Thank you for your question.
It is very common to experience CD4 fluctuations. this may be the case now even though one result is much lower than the other. Once you are on treatment the most important thing is that your viral load remains undetectable.
There are 2 different strains of HIV. Very few people have HIV-2 which is a much less aggressive strain and found mainly in West Africa. Most people have HIV-1. Your CD4 fluctuation would not be as a result of the type of HIV you have. It also does not mean you are going to become ill again. A CD4 fluctuation is very different to seroconversion.
For more information about CD4 count fluctuations please follow this link.
Some people on treatment though do not get a CD4 increase. This perhaps affects up to 10% of people and the reasons are not known. If your CD4 percentage (CD4%) is relatively high (22% is about the same as a CD4 count of 350 and 12-15% is about a count of 200) then this still gives you good protection against infections.
Research is also looking at other ways to explain why CD4 counts do not always increase, so there may be more treatment options for this in the future.
I’ve been poz since 1994. I’ve not always been the best at staying on meds and have had a few opertunistic infections but always recovered from them with having the best medical team at U.T.M.B. on Galveston Island. Now I’ve been on the same meds now for about 4 years which is Truvada and Kaletra along with a bactrim everyday. I’ve not missed many doses at all. Now my CD4 count has gone from 250 down to 25 in just 6 months. It took a few years to build it up to 250. How does it fall so fast and take years to go up?
Hi Lyn,
The change of drug back in 2010 was likely to be because of the side effects which were found to be related to one of the drugs in stalanev (called d4T). It was very normal for this drug to be changed because of this.
Unfortunately adherence problems are common in adolescents taking ARVs. Being a teenager is a difficult time and it’s not unusual for young HIV positive people to miss doses of their meds. This can lead to resistance though, as seems to be the case with your daughter.
It is very good that you have been able to have a drug sensitivity test to see which drugs she is resistant to. These tests aren’t always available in poorer countries and knowing this information means you have a much better chance of finding a drug combination that will be effective for your daughter. Even if she does have some resistance to many drugs it is still likely that there will be a combination potent enough to treat her.
Without knowing more about the infection your daughter currently has it is difficult for me to comment on the doctor’s decision to delay starting the new drug combination. It is unusual though for somebody with a CD4 count this low to be delayed more than a week or so before starting a new combination. This is because the danger from having a low CD4 count is usually greater than any danger of drug interactions or side effects in treating these other infections at the same time as starting ARVs. You should check this with your doctor and make sure that she explains why she is making this delay.
Hi Rebecca
Thank you for your fast response Rebecca. may God bless you.I live in Zimbabwe and my daughter started on stalanev in 2005 with a cd4 of 9 at a government hospital programme. Then, she also had severe chest infection but she pulled through. In 2010 the drug regime was changed to zidovudine and another drug am not sure why but it was for everyone, thats when her problems started. Her cd4 was 357 then and she started having severe side effects and her cd4 dropped rapidly to 65, 57, then 55 and lost about 7 kg within 4 months. The hospital had no other alternative then so I had to go private where she got Truvada/Nevirapine. She improved a little bit in her physical health but am sure she did not adhere well since she is in boarding school. Since this time she has been on and off and she has suddenly succumbed to these infections. She had a drug sensitivity test last week and it shows she is now resistant to most of the drugs including the nevirapine that she is taking. I have been to see a doctor and she said we should treat the infection first before changing her drugs since she has high temperatures. Am really worried and she is very stressed beacuse she has to write exams this year. Please help her to pull through.
At the moment she has chest infection, difficulty in breathing, diarrhea, vomiting and loss of appetite. She is taking Truvada, Nevirapine, Cotimoxazole, ciprofloxacillin, nutritional supplement and domperidone
Regards
Hi Lyn,
If your daughter’s CD4 count has dropped while she is on treatment this may mean she has developed resistance to one or more of her meds. Has she changed treatment at all?
It’s important that your daughter get access to ARVs that are effective for her. Herbs do not treat HIV. Can I ask which country you live in?
Can you tell me a bit more about her care – the drugs she is using and the infections she has?
A CD4 count of 16 is very low and it is important that she is being seen by a doctor.
my daughter’s cd4 has dropped to 16 and shes got severe opportunistic infections which are now difficult to treat. She has been on med since 2005. When she started the cd4 was 9 then rose to about 357 and now shes a teenager its dropped to 16 maybe shes not taking it correctly. If some could help me on what to do others advised hebrs but am afraid to use them
Hi Diana,
With any unexpected CD4 result it’s important to have another test to confirm the result. It is not unusual for CD4 counts to fluctuate and it’s important to check whether this is a real result or if your CD4 count is back up on another test. If your CD4% is stable at 22% then this is unlikely to be anything to worry about- do you know what your CD4 % was at your previous test?
i am on Haart and my cd4 has been increasing but saddely has fallen from 684 to 485 i dont know my but cd4 % is 22 can somebody help me to stop worrying by giving information why cd4 has dropped
Hi
Thanks for posting your experience. It is great that you have responded to treatment so well and that your life is going so well.
I wouldn’t worry about your CD4 count which is doing really well. Any results between 700 and 900, for example, would be seen by your doctor as being pretty much the same. The day to day fluctuations could easily knock the result of the test up or down by 50 without your immune system being any different. These cells move between your lymph nodes, blood and other body compartments continuously.
Any result above 500 is commonly referred to as ‘normal’ and you are well above this. CD4 counts slowly decrease as we age, but this is more in your 60s and 70s and after, but even this does not necessarily it relationship to your health. So expecting your count to rise much more may be unrealistic, and also not necessary to continue in good health.
So long as your viral load remains undetectable, HIV is unlikely to cause any direct problems in the future. HIV-positive people have a slightly higher risk of some of the health complications associated with ageing, but it sounds like you are already made changes that with help keep you well.
Hey
My CD4 was below 200 about 6 years ago when I got clean from alcohol. I have been using meds for about 8 years. In the past year, my CD4 went up to about 800. My most recent CD4 was 761. So like now I am worried about why this drop occurred. The viral load has been undectable for the past 6 years of my soberirty.
I keep myself fit. My doctor told me to stop taking creatine which I used as a body building supplement. Now I use (with the doc’s approval) testo and nitric oxide supplements. My diet is healthy. I dont become ill except for usual winter influenza. Psychologically and emotionally, I am more ‘sane’ than I have ever been. So I am thinking that I am going to get ill and all that. What am I doing wrong? How do I get the CD4 above 800 again?
I was diagnosed more than 20 years ago. I am 50+.
Thanks
Hi there
I have experienced a similar situation, in that my CD4 blood results have remained relatively low over the 18 months I have been on meds. Over the course of the 18 months my CD4% has increased by just 1% which equates to a CD4 cell count of about 25!
The co-receptor HIV uses can have an effect on the rate at which CD4 cells are destroyed by HIV. Most “wild type” virus uses the CCR5 receptor, and as a result it is only that infected CD4 that is destroyed. This is the method by which CCR5 antagonists (maraviroc) are able to supress HIV replication.
The other co-receptor HIV can use is the CXCR4 receptor (called X4), and this induces a phenomenon called “synctium inducing”, which in lay man’s terms means the infected CD4 cell becomes surrounded by other CD4 cells and they all clump together, and are destroyed as a result of this clumping together. Thus the rate of destruction is greater with HIV that is predominantly using CXCR4 receptor to enter the CD4 cells.
My CD4 cell count crashed over a 3 month period from 800 to 330, and the percentage from 28% to 17%. Interestingly before I went on meds I was often undetectable and never had a VL over 2000. I only started meds because of the CD4 results.
I have an undetectable viral load and have never had any rebound over the 18 months I have been on meds. My current CD4 % is 17.6 and has remained in this ball park for the 18 months I have been on treatment. I have never been unwell, not even with the common cold, but it takes time to get used to this relatively low CD4 result. I remained anxious for at least 12 months willing my CD4 results to improve, but I have given up on that, as time has shown me that many people can be perfectly well with low CD4 counts.