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 Hazel,
Because your viral load is undetectable, this means the meds are working. Therefore it may be a CD4 blip. For more about this, please see the above post.
Hi
I started taking treatment in 2007 n my cd4 count was 100,it went up to 690 to my surprise when i go for check up in march this year it was 452.bt viral load is undetactable.what could be the cause?
Hi Herrera,
When you say that your mothers liver has been eaten up, what do you mean? Also, how long has your mother been on ARVs? What is she taking? What is her CD4 count? Does she have any other health problems?
My mother is on medication and is always on a balanced diet. However, she always falls sick and her liver has been eaten up.
Her legs are much affected, they always develop wounds. Please help.
Hi Aman,
What medication is your mother taking? How long has she been on it for? Do you have her viral load results? If you could get back to us, we’ll be able to help.
My mother’s taking medicine but her CD4 drop has gone down to 216. Six months ago it was 600.
Hi Chidi,
There can be fluctuations in a persons CD4. Have you talked to your doctor about this?
I am undetectable at the moment but my worries is why my CD4 is dropping
Hi Chidi,
At this stage your viral load should be undetectable. Do you have any other viral load results? And did you have any resistance tests done?
Yeah. I am on Efavirenz 600mg, Lamivudine 300mg and Tenofovir 300mg. Started June last year