Dear Sir,

I have started treatment 3 years now with Atripla. Although my viral load in undedectable I still have only 400 CD4. In one point I went up to 500 but I am back to 400 now. When I stared therapy I had 200 CD4.

Do you think that this is a risk for my health? Do I have to start thinking of changing my meds?

Thanks for your question. I am glad that you have had a good response to treatment.

The only thing that the meds do is suppress the HIV. As long as the viral load is undetectable the meds are working.

The increase in CD4 count comes from your own body. Once the virus is suppressed, it is not there to kill off the cells so they can survive and grow. Some factors that may make the CD4 recovery more slow are starting out meds at a low count (nowadays we start at 500), being older (age over 50), poor nutrition (especially low vitamin B12 or folate), having an active infection (any of the opportunistic infections or chronic infections like Tuberculosis or cryptococcus).

Switching meds (such as to a protease inhibitor may slightly increase the number but may not add any safety to you).

Best, Joe