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 Saraphine, are you on treatment? If yes, then this viral load change might be a blip or might mean treatment is not working. Either way, in the UK this would be checked by having another viral load test.
My viraloud is above 1000 what they about dat
Hi Mark, it sounds like you either needs a specialist doctor or a team that can look at your care.
A small percentage of people do not get increased CD4 counts, even when viral load is undetectable. There is not an easy solution to this. Do you know your CD4 percentage? (CD4%). PML needs specialist management. CD4 still is important at lower levels, but the terms AIDS is generally historical.
If you are in the UK please email me at: simon.collins@i-base.org.uk
I just recently got my CD4 count back from last month. I’m just now finding out my CD4 count has been getting lower each of my visits. First because I was diagnosed with PML which is a very rare infection of the brain. Anyway my count has been dropping the past few doctors visits 314. 292 and now it’s 200 which I guess now means I have AIDS should I be put on a different medication or what. I keep two stories one will say your cd4 count doesn’t matter as long as you are undetectable which I am and have been for years. But then I hear If your cd4 count is low you need to be worried. Need help because I’m about to lose it
It’s good that your CD4 count has made this recovery from 22 cells up to its present figure. Your treatment is working. But your viral load is the more important test to find out if you’re at risk of other infections.
Once your viral load is undetectable your CD4 count will increase. But this is usually slow, and it goes up and down while it increases.
The CD4% is the percentage of white blood cells that are CD4 cells. A CD4 percentage of 12-15% is considered similar to a CD4 count of 200. A percentage of 15-20% is similar to a count of 300.
You can find out more about CD4 percentage in a similar question here.
My CD4 at the time of test was as low as 22, eventually rose to 122, after which to 274, then to 374 and dropped to 302 while CD4% remains static at 22-24%. Why? Am l at risk? And my BG is 0+. Please asist and reply.
Hi there, I have been positive for 12 years. I am 31 years old and currently on Atripla.
When I was first diagnosed, my cd4 count was 224 so I began treatment immediately. The cd4 count gradually increased and seemed to stabalize around the 560 area.
I’ve recently gotten my semi annual lab results back and they have dropped to 400 and my viral load undetectable.
My concern is that my body is starting to reject the antivirals and I may have to begin a new regiment.
Any advice to put my mind at ease.
Hi. There are several things I don’t understand about your post. Was the CD4 machine faulty for both test results (ie the 16 and 22)? What is the hospital doing for other people and is this problem going to be fixed soon? If the first test was accurate, then in the UK you would have all three of your drugs changed to another combination. With a CD4 count this low it sounds like your current HIV treatment stopped working, perhaps a long time ago.
Are you currently on medication for the TB? This makes HIV treatment a bit more complicated, but you should be on effective treatment for both HIV and TB.
It sounds like you should contact the hospital again promptly or go to a different hospital for a second opinion. Even if the CD4 machine has a problem, you could switch to a new combination so your health is protected until it is fixed.
I ‘ve been on a combination of AZT, lamuvudine and nevirapine snce 2005. Recently I came down with TB with my cd4 count falling to 16. After 3 months my cd4 count increase to 22 but I am so weak. D doctor at d hospital told me the cd4 machine is faulty so they will wait till it becomes ok before they change my drug. Pls advice me on what to do do
Hi Tony,
I’m sorry to hear about this sudden drop in your CD4 count. It’s important to have any unexpected drop in CD4 checked to make sure that this is not a lab error. If your CD4 count really has dropped to 25 it is very likely that you have resistance to one or all of the drugs in your combination and that you will need to change treatment. It is unusual to develop resistance when you are being very adherent, but it may be take you had some past resistance. If you are resistant to your drugs you would also expect your viral load to be very high- do you have this monitored? It is important that you see your doctor about this and deal with this right away. A CD4 count of 25 is very low, and you are at risk of developing opportunistic infections while it is at this level. Please see this previous question for more info.