Dear Doctor,

I was diagnosed with Hiv last November and started my medication of Atripla in January with a low CD4 of 160 and a VL of 30,000 - for the last 6 months my VL has been undetectable which is very good but my CD4 count has only risen to 315 in 9 months of treatment. I just want to ask if i am making all the right progress and if eventually my CD4 will rise? I take my medication with military precision and I have never missed a dose.. that's why I feel a bit down. Any feedback would be greatly appreciated.

Hello,

Unfortunately, the degree of immune reconstitution (recovery) is quite variable in HIV disease, due to many factors involving both the virus (viral strain, etc.) and the host (immune response immune integrity, etc.). We generally try to begin combination antiretroviral therapy before the CD4 count becomes severely depleted, as the chance of preserving immune function is greater. Currently, the guidelines recommend beginning treatment when the CD4 count drops into the 300-350 range. Many HIV specialist are now recommending starting at even higher CD4 counts (500 or higher). That your HIV plasma viral load has been consistently suppressed to undetectable limits is very encouraging and shows an excellent virological response to treatment. Your immunological response, an increase in CD4 count from 160 to 315, is also significant. Will your CD4 counts increase further? No one can say for certain. What's important is that you maintain an undetectable viral load and continue with general good health measures (nutrition, exercise, rest, decreased stress, no smoking or recreational drugs, limited alcohol, etc.)

Good luck.

Dr. Bob