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.
Thank you very much!
I am writing from India.
I am taking statin a day. Will also try to talks to a better doctor.
Thanks
Rob
Hi Rob
Please talk to your doctor about this as the answer will depend on which alternative combinations ate available in your clinic.
If you are not having any other side effect from your current combination, then taking another pill for your cholesterol – for example a statin – is common and safe. This should usually also be with advice on diet and exercise.
Even if you switched HIV meds, you might still need the statin because the high cholesterol might not be caused by your current HIV meds. This is why it is important for you and your doctor to talk about options.
Which country are you writing from?
Thank you
Another question:
I am on Tenofovir Disoproxil Fumarate / Lamivudine / Efavirenz Tablets -300/300/600mg and based out of India.
This tablet works very well to suppress my viral load however I am on tablets to control my cholesterol levels as this ART increases my Lipid levels.
I’m 30 years old, should I change ART or continue taking cholesterol control tablets ?
Kindly reply.
Hi Rob,
Please see this similar question on why does the CD4 count go up and down.
Having a cold or other infection can affect your CD4 count. Please see Rebecca’s answer here.
And here’s a link to info about your CD4%. The CD4% can indicate whether this is a real change or a fluctuation.
It’s great that your viral load is always undetectable. That looks like the meds are working well.
My CD4 count on 15th May 2018, when my treatment was started was -279!
On 30th of June, Post I reached undetectable status it was 380.
On 4th September it was 569!
On 21st November it went down to 439. (I had bacterial chest infection which was cured)
On 8th January it further went down to 408.
On 22nd February, it further went down to 386 (and I’m having 99.7F fever and cold/ congestion/ running nose) also a cyst on my left eyelid since 1.5 months (using drops and warm compress for the same per my ophthalmologist who doesn’t know my status)
All this time, the viral load is undetectable.
I am on Tenofovir Disoproxil Fumarate / Lamivudine / Efavirenz Tablets -300/300/600mg and based out of India.
I am unable to understand the decline in my CD4 counts and worried if I have developed drug resistance.
Kindly reply.
Hi Robert,
It’s great that you’re fully adhering to your meds. But do you have access to your viral load results?
And what does the clinic say? The way to tell if the meds are working well is to look at your viral load result. If it’s still undetectable, then they are working. So the change in CD4 can be okay.
But it’s a good idea to check your viral load with the doctor.
I am fully adhering to my drug (lamivudine,nevirapine & Zidovudine – combination) since my diagnosis. My CD4 was 411 in May, 2017,376 in June, 2018 and January, 2019 to 257. Later check in case of testing kit problem after just a day dropped down 251. Why could this be happening to me when I am 100% adhering to my daily dosages.
Hi Robert,
Do you know what your viral load is? Are you adhering to your treatment?
I am diagnosed in 2017. In October, 2017 my CD4 count was 411, and in May 2018 my CD4 count was 376 and now January, 2019 my CD count was 257. Can you please explain why this is happening.
Hi Siya,
It’s great that you’re taking Tribuss. It looks like it’s working very well and keeping your viral load undetectable.
But CD4 counts go up and down, even during a single day. Please see these frequently asked questions about CD4 counts.
Doctors now use viral load tests as a way of making sure the HIV meds are working. But you are doing everything you can by taking them without missing any doses.
Can you discuss your CD4 count again with your doctor. You can say you’re worried and ask them to explain it in more detail.