Hi doctor, I would like some clarification on some things about declining CD4 counts. The point of meds is to reduce the viral load to undetectable. But some people with undetecable viral loads without meds are losing CD4 cells like maybe at 50 a year or so. If this is true, about they had 800 at time of infection, then it would take 16 years to reach a zero CD4 count. YOu tell people that with good aherence to meds, epople may expect to live close to a noraml life span. What good would meds do if a drop happens already at an undetectable level?

There is a very small subset of people who are on treatment with prolonged undetectable viral loads (< 50), and in whom CD4 counts continue to drop. New data indicates that <50 does not necessarily mean zero. Some people continue to have replication going on, which is infecting and killing CD4 cells. These folks may require additional HIV meds, or perhaps IL-2 to help boost CD4 counts.