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CD4 variation - what is to be expected?
Aug 10, 2013

I'd like to start out by thanking you all for the great work you do here and the support you provide to HIV+ people around the world in the form of information and debate. I've been diagnosed as HIV+ in March last year and this website was instrumental in giving me comfort and knowledge about my condition in those first few months. Thank you very much for that.

I have been doing well on treatment (Atripla), but here is my doubt: when I was diagnosed my viral load was around 5,000 and my CD4 count at 439 (18%). Just a couple of months after starting treatment the VL went to undetectable and has remained so since then. The CD4 count has varied up and down in absolute terms but steadily increased in its percentage (21%, 25%, 28%, 31%...).

Well, at least until the last two lab results. In January I had my highest count since I was diagnosed: 31% (596 cells/ml). Then the upward trend reversed: in April it went to 29% (503 cells/ml) and now, in July, to 27% (496 cells/ml).

My care provider says I have nothing to worry about and that this variation is irrelevant. But I can't deny there is a sense of frustration with this decrease. Having the viral load suppressed for more than a year now, I thought the CD4 count (the percentage that is) would only go up, until it reached (close to) normal levels and would remain there.

What should I make of all this? I know there is nothing I can do specifically to increase the CD4 count other than to fight the infection taking ARVs. That I have no problem doing: never missed a dose and will continue not to!

Thanks again and greetings from Switzerland.

Response from Dr. Holodniy

I agree with your provider and am not concerned, particularly given that your viral load is undetectable and your HIV med adherence is not an issue. The CD4 count can vary because of time of day, stress, after immunizations, because of other ongoing infections, among other reasons.



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