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Undetectable but rapid dropping CD4
Jun 11, 2008

I have been dx for 8 years. I have always had a CD4 higher than 900, and an undetectable viral load. I started treatment 5 years ago (Sustiva, Epivir, Viread)..then switched to Sustiva, Truvada, and then Atripla. I had a relapse of Crystal Meth in Jan 08 but have been clean since then. I missed about a weeks worth of Atripla when I relapsed. My labs have been as follows:

Feb 08 - 1500 CD4 - 38% - Undectable

April 08 - 740 CD4 - 42% - Undetectable

May 08 - 520 CD4 - 22% - Undetectable

I am getting concerned with the rapid dropping of my CD4 and percentage. What kind of tests/labs should I advocate and ask for to begin ruling things out....

Response from Dr. DeJesus

Thanks for posting your question. You had a very high CD4 count before you relapsed on crystal meth. It is possible than during- and post- your crystal meth relapse your immune system may have become somewhat compromised. On the other hand, your viral load has now remained undetectable which is very good news.

CD4 count absolute numbers are very unreliable when they are very elevated. They also tend to vary quite a bit between measurements, sometime within a few hundred cells between measurements. The CD4 % is less variable and more reliable.

Looking at your numbers, it seems to me that your CD4 in Feb of 1500 cells was artificially (erroneously) high given that your CD4% was only 38%. In fact your numbers in April (CD4 740/42%) are probably better than the numbers in February, because your % were higher! So you only have one value that appears to be lower (the values in May with a CD4 of 520 (22%). Even those values are still very good, and the likelihood is that they will again go back up. I will not worry at all about those results. Keep your viral load undetectable by taking your meds as instructed and avoiding again crystal meth. You will see again those numbers increasing or stabilizing soon. Good luck and stay clean!



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