Dr. Holodniy, I am 57 yr old male first diagnosed in 11/2011. (Because of numbers below,the ID specialist speculated that I may had HIV for 3-4 years.) At that time my VL=46000:CD4=374 and %=20% No HEP: No Resistance:HLA negative: Currently taking Truvada/Isentress. In 12/2011, (when I started meds: fist Atripla, then Epzicom/Isentress and now for 3 months Truvada/Isentress) my CD4 went down to 322 and 17% lymphs. Numbers have basically increased during testing. In May 2012, my CD4 was 510 with 33% lymphs. VL=undetectable Just this past week, June 26, CD4 declined to 489 but the lymph % increased to 37%. (New VL results not back yet.) I was hoping to be able to get my CD4 well above 500 at some point and am somewhat concerned. I know you probably get asked this frequently but why isn't here a correlation between rising lymph % and CD4 count?? One more quick question, please: Is there a tropism test readily available that can be done even if your VL is undetectable? I may need to come off of the Tenofovir and my ID doc is considering Maraviroc/Emtriva/Isentress as a possible option.(would you give your opinion on that regimen??) Thanks so much for your consideration.

First, you have had a great response to treatment. I don't think there will be a problem in getting your CD4 count over 500. Unfortunately there is no good answer as to why there is not a direct correlation between CD4 count and percent. It likely depends on how long infection has been present, how many CD4 cells (and what kind) been destroyed in the process, and whether HIV treatment can result in optimal recovery or not. And yes, there is a tropism assay that is available that can look at the DNA from blood cells in people with undetectable viral loads in blood plasma.