Question

Why isn’t my CD4 increasing?

22 March 2013. Related: All topics, CD4 and viral load.

Hi there, I wonder if you can help me.

I had seroconversion illness in May 2010.

I went to the hospital and have never felt so ill with the symptoms (being sick, night sweats etc) etc. They sent me home saying it was a bug. After a few days it continued so I went back where I was tested for an array of illnesses. To my shock I found that one of the hiv tests had come back +ve and the other two negative and was told to go back in 6 weeks for another one.

I did and was told I had hiv. After getting my head around it all I started to see a HIV consultant who took bloods etc to find out what was going on, I was reassued that I was going to be fine as I had been caught straight after seroconversion and some people dont get picked up.

My CD4 was in the lowest part of the dip (around 229) and was told it would recover for a while before I would need to go on meds. I was closely monitored for a few months and my CD4 contined to be around 250-300 (15%) and viral load was dropping. My consultant told me that it was their opinion that I should start meds as although my viral load was decreasing from 1millon copies to 50k my CD4s were not recovering.

I did and started sustiva and truvada, after 4 months I had reached undetectable and I was so made up. The next part i was told as there was very little virus going around my CD4 count would bounce back. I have now been on meds and been lucky enough to have no side effects for 30 months now and I have NEVER missed taking them before going to bed as I have read all about importance of adherence.

My CD4 range from 320 to 280 at 30% each test. My question is really I have read many people reach the magic +500 cd4 counts and wonder after the seroconversion illness I started meds 4 months later and then another four months later was undectectable. Is there an explanation why they have not climbed also I have read that the percentage relates to a count also and that a percentage of 30% is around 500 as CD4s fluctuate day to day.

Answer

Answer: Rebecca McDowall

Hi,

Thanks for your email. I’m sorry to hear about the difficult seroconversion you experienced, but I’m glad to hear that you had such a good response to treatment.

The main aim of treatment is to get an undetectable viral load. This means that the virus isn’t able to replicate and infect new cells. Usually a CD4 count increase does follow. But there are a few people who don’t see a CD4 count increase on treatment.

Unfortunately the reasons for this aren’t well understood. It may be that you have a naturally lower CD4 count than most- the ‘normal’ range for CD4 counts without HIV is 400-1600, but a few people can be above or below this.  Your CD4 percentage is higher than usual for this CD4 count, which suggests that you have a good proportion of CD4 cells in comparison to other immune cells.

Although it’s easier said than done, try not to focus too much on your CD4 count results. So long as your health is good, and your viral load remains undetectable, it is unlikely that this is anything to worry about.