For about the last 4 years I have had an undetetable viral load and a cd4 count that fluctuates between 350 and 490. What causes the fluctuations in the cd4? I am 50, fairly healthy and have had no minor or serious problems since my initial diagnosis. Is there anything I can do to raise my cd4 so that I am not constantly worrying about it?

Given the duration of your infection, I would not be concerned about fluctuation in absolute CD4 count. Another number to follow is the CD4 percent, which is a more stable number time. My guess is that your CD4 percent had not changed significantly over time. The absolute CD4 count can fluctuate due to a number of reasons like stress, time of day, type of assay, other ongoing infections, recreational drug use, among others.