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Fatigue and AnemiaFatigue and Anemia
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variation in cd 4 count
Jul 23, 2011

I was diagnosed with hiv some two months ago with a viral load of 21000 and the cd 4 count of 140. I was put on sustiva and truvada and after 4 weeks my cd 4 went up to 190 and the viral load dropped to 97. I had a second blood test after 9 weeeks on trearmrnt and the viral load is undetectetable, however my cd 4 dropped to 180 and a percentage of 13 from 18. I canr understand this

Response from Dr. Frascino


The good news is that your Sustiva + Truvada regimen appears to be effective virologically (your HIV plasma viral load plummeted from 21,000 to undetectable levels). The not-so-good news is that you are not seeing a corresponding response immunologically. We don't completely understand this phenomenon, but it's something we see not infrequently. See link below for additional information. Inadequate immune restoration (rise in CD4/CD4%) is seen most often in HIVers who don't begin antiretrovirals until their CD4 counts are severely compromised (less than 200). It's one of the reasons we stress early diagnosis and treatment.

You've only been on ART for a relatively short period of time, and your immune system has been severely impaired by HIV. Consequently I would give your current regimen a bit longer, particularly because your HIV plasma viral load is undetectable. It's possible your CD4/CD4% will being to rise with persistent suppression of viral replication. If it doesn't, you could try an alternate regimen as discussed in the archived questions. Don't lose hope!

Good luck.

Dr. Bob

Difference between CD4 and Percentage (CD4 count versus CD4%, 2011) (LACK OF CD4 RESPONSE DESPITE TREATMENT, 2011) Jul 22, 2011

Antibodies of Syphilis and HIV
How does HIV affect TB? (TB/HIV CO-INFECTION, 2011) (TUBERCULOSIS AND HIV, 2011)

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