Question
What could explain the CD4 count drop?
25 June 2009. Related: All topics, CD4 and viral load.
Should I worry about a another drop in my CD4 count? Whilst my VL has remained undetectable, my CD4 count has dropped from 260 to 210 four months ago and again this month from 210 to 200. There have not been any changes in the CD4 percentages and my doctor says he’s happy with these results. I thought that once on HAART your CD4 count should increase or at least remain the same? I don’t smoke, I exercise regularly and do not take any recreational drugs and I actually feel better than when my CD4 was higher. Any idea why this is happening?
Answer
In fact, sometimes there are results like that and they are called discordant results. Generally speaking, data show that the CD4 decline/increase correlates to the VL only on population level and personal fluctuations are quite large.
Factors that influence the CD4 count are:
– Seasonal and diurnal variation (lowest at 12:30 PM, highest at 8:30 PM), surgery, viral infections, tuberculosis.
– Decreases with some medications (e.g. corticosteroids, especially with acute use, less pronounced with chronic use; PEG-IFN, IFN; cancer chemotherapy).
– Acute changes in CD4 are more often due to redistribution of CD4 in lympathics, spleen and bone marrow.
– Lab mistake (surprisingly frequent)
A very detailed answer to a similar question is published here, you may find it useful.
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