Hello Dr. Holodniy, my partner recently was diagnosed with IRIS, a severe form resulting in a pericardial window secondary to cardiac tamponade. He is home and doing well. His CD4 count fell from 157 to 74 and his lymphocytes are falling as well. His viral load is 80 currently. He is taking Truvada, Norvir, Reyataz and mepron for PCP prevention. He was never diagnosed with HIV, but was diagnosed with AIDS in October of 2010. At that time his CD4 was 4 and his viral load was 968,000. Should we be concerned with the dropping lymphocytes and CD4s since the viral load in still going down???? What could be causing this?

You don't indicate whether the doctors told you what was the cause of the IRIS or the tamponade. If this was the result of another infection, then yes, the CD4 count could have decreased as a result of that, even on HIV treatment. I would consider this a minor setback, as long as the viral load continues to go down. Once it is undetectable and whatever caused the cardiac issues are resolved, i would predict the CD4 count will continue back up.