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Moderate CD4 count, but still low %

Jun 23, 2013

I was diagnosed with HIV after being hospitalised for toxoplasmosis 2.5 years ago with a CD4 count of 55, and % of 5. I started treatment immediately and after a few changes settled on atripla. My viral load has, apart from one small blip, been consistently undetectable. My CD4 count has consistently risen and for the last year my absolute counts have consistently been around 500. However, the CD4 % is still quite low at around 16%. I have a few questions about this. 1) Is it normal for the % to be at this level when the counts are at around 500? 2) Would you expect the % to rise and 'catch-up' with the absolute count, or do you think that the absolute count will actually fall to reflect the lower %? 3) Is the low % likely to affect prognosis? I have read recently that people who maintain counts of over 500 have a pretty normal life expectancy, do you think this will be the case here as well, or will the fact that the % is low mean that my prognosis is affected?

Thanks for your thoughts on this matter and all the other help you offer people.

Response from Dr. Holodniy

1. Yes, this is certainly seen, particularly in people who start HIV treatment when their CD4 count and percent are so low. 2. Good question. I think you will likely see some decrease in CD4 count and some increase in CD4%. In general, your CD4 count is higher than what would be expected for a CD4% of 16%. 3. Again in general, we know that a CD4 count of <200 or a CD4% of <14% puts one at significant risk for developing serious infections. The risk is significantly less when both numbers are above that threshold. Although I think data is still emerging, it appears that maintaining a CD4 count of >500, or perhaps higher, with an undetectable viral load, offers that best prognosis, in general, the data would would also suggest that this would be accompanied by a CD4% of >25-30%. In your case, even after all this time on HIV treatment, you may still see increases over time, provided the viral load remains undetectable.

1 year ART, still detectable viral load?

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