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 Chidi, without more information it is difficult to comment. Are you taking HIV meds?
The viral load result I had was 1876.
Hi Chidi.
Though your CD4 is dropping, it may not be a cause for concern. Please see here for more info:
http://i-base.info/qa/1515
Do you have any other viral load results?
Hello, good afternoon. I just came in from the clinic now and these results were given me. Viral load is ” target not found” CD4 is 577. Meanwhile, before I started the meds, my CD4 was 987, 765, 753 respectively and now 577. I am really worried that my CD4 count is dropping gradually. What do u think would be the problem? What am I not doing right? I told the Dr about it, he says I am doing good and he hope I am keeping the rules of the drugs, not eating 2 hours before and after taking the drugs. I am on Efavirenz 600mg, Lamivudine 300mg and Tenofovir 300mg. It’s taken once daily. And I started in June 2016. What could the problem be as I think my CD4 is supposed to be increasing instead of reducing.
Thanks
Hi Aarominesemple,
Are you saying that you’ve been on treatment for nearly 2 years, and your CD4 is now 21? If you are, then its highly possible that your medication isn’t working properly. What was it when you were diagnosed? And what is your viral load? Have you talked to your doctor about this?
Just found out it is 21, but I’m on treatment. In April it’ll be two years.
CD4 is 21
Hi Aaromiesemple.
A CD4 of 21 is low. Therefore, if you haven’t started treatment yet, its important that you do. For more info about low CD4s please see here:
http://i-base.info/qa/4643
If you need anything else, please contact us.
Hi Ada,
When you were diagnosed what was your CD4 count and viral load? Are you on treatment?
A viral load of 20 is great. It means that your viral load is undetectable. Which in theory means that the risk of you transmitting HIV to another person is close to zero. It also means that the level of virus in your body is very low.
For more about viral loads, please see here:
http://i-base.info/qa/6570
A CD4 of 165 is low. However, this may be much higher than when you were diagnosed. If this is the case and you are on treatment, then your HIV is improving . Its your viral load that indicates that you’re on treatment.
If you aren’t on treatment, then this is what a CD4 of less than 200 means. If someone has a CD4 count of 200 or below then it means they may be vulnerable to opportunistic infections. In some countries co-trimoxazole (often called Setrin or Bactrim) is given as a prophylaxis to be taken daily to prevent pneumonia and other infections.
If you could let us know if you’re on treatment that would be great.
My CD4 count is 165 and viral load 20. Pls what kind of result is that?