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re:CD4 collapse even though undetectable
Apr 26, 2012

Hi Joe, In January I asked you this question about my decreased CD4 count, despite long-term viral control. This is reproduced here, along with your answer: (6th Jan) 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.

Response from Dr. McGowan

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

Thanks again for your reply here. A few days ago I had my quarterly consultant meeting and my CD4 count has further gone down to 150 and the percentage has also gone down to 19 from 24 last time. So, to recap, the CD4 count trend is 320...220...150 and percentage 24, 24, 19. My consultant did a physical check around my lymph nodes (legs, abdominal area) but couldn't find anything. I am in superb health and train in the gym 5 times a week and eat fairly well, drink in moderation and no recreationals. I also have had no colds or vaccinations. I don't understand what's going on. I'm scared that if this trend continues, I will be in double-digits the next count! What would you do if I was your patient? Kind regards for all your help, Michael.

Response from Dr. McGowan

Dear Michael,

Thanks for the follow-up. Seems as though the numbers have returned to where they were prior to last year. Since you have no symptoms or weight loss, diarrhea, sweats, etc. It is hard to focus on any specific work-up since you have no complaints. Standard screening for tuberculosis (a skin or blood test), other chronic infection (herpes, CMV), anal HPV screening. If all is negative and trend continues would consider a CT scan of chest, abdomen and pelvis to look for hidden lymph nodes or inflammation. Work with your doctor on this.

Best, Joe



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