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.
Hi everyone,
I sort of worried that me cd4 has suddenly dropped from 400+ to 200. I did have covid in October which was more like a touch of flue. Didn’t not last no more than two or 3 days. As of this month me count is still 200 but also undetectable. Like every else, my doctor said there is nothing to worry about. I do everything right; cardio, weight lifting, running and try to eat right. Unfortunately, I suffer from idiopathic insomnia which is untreatable. I actually think that’s the issue with cd4 count to drop.
Anyone have any suggestions?
Hi MF, have you been offered a repeat test? A drop of this significance would require a second test to ensure the result is not a lab error. Do you know what your last viral load test was? and are you adherent with your medication e.g, do you take it daily?
I’ve been on a art called odfesey for the last 4 years my cd4 has gone up and down slightly my last test put me at 1194 which was great but I just got tested again yesterday and my cd4 count took a nose dive to 390 the last blood test was 5 months ago I don’t know the hiv results yet but should I worry? What could’ve caused such a sudden drop?
Hi Soso,
Can you give us more detail about your weight loss.
Also what is your CD4 history?
Good day
Ive been on arvs for 4 yrs and my cd4 count goesxup and down and lately I’ve lost lost of weight and having difficult in gaining it back what coild be the problem ive tried everything but npthing seems to help and my doctor has confirmed that it has dropped yet he says its nothing to worry about please advice
Hi Lee,
What’s your CD4 count history?
Hi, i also have the same problem, my cd4 count keeps going down and down but viral load is undetectable, should i be worried?
Hi Sean,
You didn’t say whether you are taking HIV meds (called ART)?
As long as your viral load is undetectable on ART, your CD4 counts should got higher again. Is it possible to have another test to check these results?
I am in the same situation.
I had a terrible seroconversion 4 months ago. My cd4 was 230. After that it rose to 413.
Since then I have been in gym every day. Eating sleeping well and feeling strong.
However my cd4 is now down at 213.
So despondent.
Will it go back up?
Hi Rob,
Thanks for this, and good luck with talking to a better doctor.