Hi Joe,

For the last year I have had A CD4 count in the mid 300's after two years of hovering around 180. I have been undetectable on Darunavir (r) and Maraviroc for the last three years. However at my appointment today the latest count of 220 was a disappointment. What caused this? For the last few months my gym routine has been curtailed by an injury and I became a couch potato and not eating too well. Could this have contributed to the drop? The percentage has remained constant at around 25%. Is there any evidence that selenium / zinc supplementation should boost immune strength? Finally, if it was to collapse any more (say, less than 100) would this put me at risk of opportunistic disease, despite being undetectable for 3 years? Thank you for time. M.

Dear M.

There is an expected fluctuation (ebb and flow) to CD4 counts. After all, we only measure CD4 counts in the bloodstream and most CD4 cells live in the tissues, so we only see the tip of the iceberg. Since the CD4 percent has been stable and your viral load remains undetectable, we know any changes are not related to HIV. If the recent Cd4 were after a cold, fever, or vaccination it could dip down. I never make assumptions based on any one count due to this normal variation. See what teh next number shows.

As far as micronutrient deficiencies are concerned, some reports have been made in adults and children that higher levels of selenium and zinc have been associated with lower viral loads (which may be a marker of immune function or overall nutritional status). Selenium deficiency is rare and zinc deficiency more common. Your viral load is already suppressed and there does not appear to be much of an effect of zinc and selenium on CD4 counts. So I would focus on a balanced diet, without overdoing the supplements.

Best, Joe