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.
My last cd4 count was 406 and was always ranking to that until i was admitted of depression last year.my cd4 count dropped to 394 and the viral load also increased.To be honest i also saw this coming because i really experienced a very tough time due to this depression,i went to the doctor and she seemed not too worried and told me to continue using my meds right and everything will come around.should i be worried?
Hi Ameer, thanks for writing about your mom.
It sounds like at some point your mom slowly developed resistance to her treatment. This meant that over time is slowly stopped working and the CD4 count steadily dropped. In most countries, routine monitoring of the CD4 count (and usually viral load) would have discovered this much earlier.
As your mom’s CD4 count is now very low, the doctor need to prescribe a new combination. You mom with also need other medicines including the antibiotic co-trimoxazole. This will help protect your mom for other infections until the new HIV meds get her CD4 count to become higher.
The throat problems might be a fungal infection call thrush (Candida) which needs to be treated with an antifungal medicine. (see this link for details: http://i-base.info/ttfa/5-opportunistic-infections-ois-and-coinfections/5-candida-and-other-skin-problems). This treatment is also urgent, so that you mom can start to eat properly again.
The other symptoms such as feeling week might be just because of the HIV or might be another infection.
The doctor needs to monitor you mom very closely over the next few weeks and months until her CD4 count becomes higher again. There are lots of reasons to be hopeful, but this all depends on careful treatment now and a new HIV combination.
As your mom’s CD4 count increases, these other infections are likely to also get better.
My mom is hiv positive. She is on ART medicines since 6 yrs now… but now she has become very weak and today she has got her cd4 count which is 26… Please can anyone say what to do??? Why is cd4 count so less while she is having ART? She is also having throat problems and not able to eat properly…please help anyone?
Hi Jennifer, does your doctor test your viral load? If yes, this is a more important test when you are on treatment. Without more details of your treatment history, it is difficult to know where this is just a problem with the test or whether your combination in no longer working. Please write back with your treatment history if this is possible. i.e. when you started treatment and which drugs you use.
4 weeks ago my cd4 count was 147, 2w eeks later it came down to 122, and 2 weeks later now it is 99. Why is it dropping so fast and I am still taking my drugs,I am very worried, please help!
Hi Nice,
What have your CD4 count results been?
My cd4 its been dropping but my viral load still undetectable anyone who knows why its been dropping ever and i dont think it will stop but i take my med right and im still well but it worries me for dropping fast
I have found this very educative and at the same time informative. I have never had such an awesome and helpful information before now. Please keep it up. Give me more.
Hi Nick,
CD4’s can and do fluctuate. Therefore, unless your viral load has increased this means you’re OK. Also a lot of peoples CD4’s never go above 500. This doesn’t mean that you aren’t well.
For reference a normal CD4 count in a person who is negative is between 400-1600.
I am experiencing the same. Everyone around me reached levels of CD4 above 500 after 2-3 months, when mine were around 460-500 and last time they dropped to 360. I am wondering if I have to ask to change the ART… I don’t have new viral load results, but last year I was undetectable.