Hello, I have been HIV positive for 17 years. When I started therapy about 12 years ago my tcells were around 490. Over the years they keep dropping now they are at 235. I am not resistant to the medications. I apparently have a slow progressing strain of virus. My Adherence to meds has been very good. Currently my doctor has me on Viramune and truvada. Should I ever expect them to rise again or is the virus "winning" at deeper tissue levels?

Thank you for your time and consideration.

Declining CD4 cells despite indetectable VL or a poor CD4 response to therapy is an area of renewed interest. Several factors seen to play a role including genetics (notably the CCL3L1-CCR5 genotype but also others) and on-going CD8 activation. In the median term, people with an undetectable viral load are at less risk than the persons with the same CD4 and a detectable VL so there is little risk you will come to any harm due to your CD4 numbers. The management is not clear. Various things are under investigation such as IL-2 (data due next year) and the addition of maraviroc to treatment (data probably later next year). In the mean time just keep taking your medications as they are the right thing for you, and keep watching the conference reports and not be concerned Best Wishes Dr Moyle