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CD4 dropping but percentage steady

Jul 12, 2014

I am concerned about my numbers. When I was diagnosed in September 2012, I was at CD4 360/13% with 36k copies. I started Complera in December 2012. Since then, I have achieved and maintained an undetectable viral load. My December 2013 result was CD4 468/16%. I was very encouraged despite my low CD4 % number, which concerns me. However, the percentage number was moving up and to the right, so I accepted the progress as a good sign. In December 2013 I had surgery for an anal fissure. Sidebar: The day after the surgery, I passed out in my bathroom and fractured 6 of my ribs. The injury complicated my recovery and my surgical sutures ripped open. My colorectal surgeon has been treating the wound as a fissure and it has not yet fully healed. In April 2014, my blood work returned a result of CD4 366/17.9%. The April labs were ordered by my former Doc that accepted a new position out of State, so I found a new ID Doc. Last week, my new labs revealed CD4 296/17.4%. My new Doc says that this is not concerning to him. However, I am concerned. When I expressed my concern to my doctor, he said that he has no use for those numbers. He stated that he probably won't be checking them at all, except for once a year going forward and that all he is focused on is viral load. Given the fact that this is MY immune system we're talking about, I have some anxiety (which I hear does not help the immune system very much either). Given the facts I have laid out, what are your thoughts?

Response from Dr. Holodniy

As you indicate, there is no real change in the CD4% over time, but a reduction in CD4 count, despite the undetectable viral load. Other numbers that would be useful to compare would include your total white blood cell (WBC) and lymphocyte counts. It is likely there has been a shift in those numbers accounting for the reduction in CD4 count despite the steady CD4%. The CD4 count is more variable and can change because of time of day, stress, other ongoing medical conditions, after immunizations, different labs or assays, among other reasons. I agree with your doctor in that I am not concerned about the decline. However, I think the frequency of testing should still be somewhat more frequent than annually.

Low CD4
cd4 decrease and viral load decrease

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