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CD4 percentage dropping
Aug 31, 2009

I have a great doctor, but another opinion here is always greatly appreciated. Background: Tested positive 3/06 vl288k, cd4=37/6% and PCP. 5/08 vl=156 and has been untect. since. CD4's have gone from 8% to 15% in 7/08, but had to switch off Kaletra due to lipid and digestive side effects. On Isentress/Truvada my cd4% went to 17.4% on 10/08, 16.5% 1/09, 14.7% 4/09, 14.5% 7/09 - with an absolute of 189 (a drop of 110 from 4/09) so we did the lab again in 8/09, and it was 15.5%/341.

Can you help me make sense of this almost year long trend of dropping and then a jump of 1%? Should I be considering switching out the Isentress (which I love) for a PI (Prezista) to possibly get a boost or at least stop the slide? We're doing labs again in 6 weeks, but my doctor who specializes in HIV cases says she doesn't see many patients that do so well controlling viral load have such a problem with just slowly increasing cd4s. I've only been seeing this doctor since January when I moved to another city so perhaps she doesn't have the history I just gave you from my own copies of my labs and is overly concerned.

Thanks for your time and your answer.

Thanks for your help.

Response from Dr. McGowan

Thank you for your question. First of all congratulations in achieving an undetectable viral load. Your hard work adhering to your medications is paying off. The changes in your CD4 count may just reflect normal fluctuations of this cell type. That is where the CD4% helps since usually, if the CD4 changes were driven by HIV, the % would also be decreasing since HIV drops the CD4 count fatser than the CD8. This decreases the CD4 share of the overall T cell count (this is what the % is measuring). When we measure the CD4 count, it is only the CD4 cells in the blood that we measure, not the cells in the tissues. As CD4 cells move into or out of the tissues to fight infection or inflammation there number in the blood may go up and down. However, the key thing is that your viral load is undetectable and I would wait to see what your next set of labs show on your current regimen especially since the last CD4 count shows a welcome increase. Best, Joe



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