When I started HAART, my CD4 were 190 and my viral load only 2000 copies. That was 5 years ago. All that time my viral load has been undetectable, but I almost gained no CD4 (current: 208). How could that be?

This is an unusual situation, but in some studies about 5% of people will have a nice drop in viral load but no increase in CD4 count. I don't know why this is the case for you, but there are several possible explanations:

-Some drugs may suppress the bone marrow and decrease the overall increase in CD4 count, although the CD4 percent will increase. This is most clear cut with hydroxyurea containing regimens, but can also occur with other drugs, such as AZT (retrovir).

-Some people may have too little ability to regenerate CD4 cells. This is likely to be due to damage to the thymus gland, perhaps by a combination of age and prolonged infection. Perhaps low levels of IL-2 or other immune factors play a role.

In my experience, people with suppressed viral load who can maintain a CD4 count of around 200 do very well, even if they don't have the immune recovery we are used to seeing. IL-2 could perhaps be an option. It is likely to boost your counts, although it is expensive, unpleasant, and requires injections twice a day for 5 days every 8 weeks.

Hope this helps

ATP