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CD4 keeps dropping while my VL is undetectable

Apr 6, 2014

I was diagnosed with HIV in February 2013. My initial CD4 count at that time was 313. I started daily Stribild in April of 2013. I have noticed that initially my CD4 kept increasing up to the upper 700's over 9 months. My VL became undetectable in 8 weeks. Although my VL has maintained as undetectable, my CD4 count has been falling with each lab visit, dropping by close to 100 points each time. My CD4 has now dropped to 376. I am concerned that my treatment is not working effectively any longer. I don't understand why my CD4 is dropping each time. Any insight you can give me is greatly appreciated.

Response from Dr. Holodniy

In order to better understand this trend, a few other numbers are needed. First, what have the total white blood cell count (WBC), total lymphocyte count, and CD4% trends been doing? If the WBC or total lymphocyte counts have decreased, but the CD4% has stayed the same (which is a more stable number over time), then something else is going on. In general, it would be unusual to see such a decline without an underlying reason. Your HIV treatment is still working given the undetectable viral load.

WBC decrease
Wild-type HIV vs. cancer cells

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