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..i was diagnosed to have positive in July 2023 with viral load 29400 and cd4 86. I was prescribed on tenofovir/emtricitabine/efavirence
with bactrim and i had complied to it. Repeated viral load in early Dec 2023 is undetected but CD4 falls to 56. For now i am good and weight gaining. I am worried if my immune response is not working or it will take some time to be worked. What i should do… The machine did not provide cd4/cd8 ratio or cd4%. I am so worried about the cd4 number. Please help
Hi Greg, while these numbers appear over the place there has been a general trend of increase from 479 to 611.
In someone HIV negative, a CD4 count between 430 and 1690 is considered healthy. This is why even though you have been on treatment for so long, there has not been a significant increase in CD4 count. This is because you are in a healthy range regardless.
For some of the lower results, do you know if you were ill or if you had recently had a vaccine? Even exercise or the time of day can effect these results. Have you been told your CD4%? This does not change as much as the actual count and can give a more accurate representation of your immune system.
Hello ,I have to many questions about cd4 count I started after meds 479 this nov 2023 ,494,401;494,403,419,485,529,523,MAY 2018=611.my question is why my number are all over the place I was expecting going up, instead I’m concerned about the numbers, there something to concern about it?
Hi Terry, the first thing to note is that as yo uhave said these are great numbers. Your treatment is still working and you are in a healthy range for all of your results.
Most importantly is that your viral load is still undetectable/20. This shows that your treatment is working and HIV is being suppressed.
When you have had the last few tests do you remember if you had recently been ill/had an infection, been exercising or even if the tests were done at a different time of day?
As for your CD4% do you know your CD4/CD8 ratio or if you have been given results for other white blood cells? While you have been having these tests have you noticed any symptoms e.g., night sweats, fevers or unintentional weight loss?
Do you have any more tests booked? Your primary care physician is still correct in that this is nothing to worry about as it is in a healthy range, though I understand why this can be concerning. Apart from being on treatment for HIV and the low testosterone, how is your health in general?
Hi my name is Terry, I am a 61 yo with hiv-1 diagnosed in 2018. I started treatment soon after diagnosed. I was on biktarvy first then in 2022 I stated cabenuva and still on it.
I have continued to watch my blood work. Over the years I’ve gone from 330 cd4 and a rna of 1500. My cd4 cells were 836 as of May. Rna of 20. Then in July my cd4 went to 678 with a rna below 20. Now in Nov my cd4 are 626 and still under 20 on my rna viral load. These are still great numbers
I do not understand why the cd4 are dropping. My viral load is undetected. My testosterone levels are a little low of 110. My tsh is in normal range
Even my cd4 percentage is 25.1 % wich is low. I’ve had conversations with my primary care doctor and he says nothing to worry about. I’m concerned. 836 to 626 is concerning to me.
Please help me to understand..
Hi Anna, how often is your viral load tested? and do you remember what your CD4 count was when you were diagnosed?
Has your CD4 count dropped recently or has it never been higher than this? and while you do have a lower CD4 count have you been on any antibiotics to prevent other infections? Usually this is called co-trimoxazole.
Hi I been on art for more than 13 years my viral load is undetectable I take my medication everyday but my cd4 is below 200 been experiencing oral thrush, frequent UTI/fungal infection and I have systemic lupus erythematosus
Hi Sibongile, are you on Bactrim/co-trimoxazole as you have a CD4 count below 200?
Has anything changed in your treatment recently? and have you noticed any other symptoms e.g., problems with your vision, pain on your scalp, nausea?
Have you mentioned these throbbing headaches to your doctor?
I have been on ART for 13 years my cd4 count is below 200 and viral load is below 40copies and am experiencing severe throbbing headache what can be the problem
Hi fk, do you know your CD4%? The percentage is a more accurate measure of how your CD4 count actually is. As you have mentioned the actual number can fluctuate. This is why it does not always give an accurate representation of your immune systems health. Has it been in the 200’s before? and are you taking treatment everyday?