Response from Dr. Sherer
I would not change your medications at this moment based on the test results that you have provided, for two reasons.
First, you had an acute illness - a 'flu' of some kind - in April when the last values were taken. It is well known that a viral infection can lower CD4 cell counts. You and your doctor can look at the percent of CD4 cells, to see if that might have changed LESS than the absolute number. This might occur with a viral infection that occupies your body's lymphocytes, resulting in a lowering of your TOTAL lymphocyte count (recall that CD4 cells are one type of lymphocyte) WITHOUT actually changing the percentage of CD4 cells.
You and your doctor should repeat the viral load and CD4 cell count when you are recovered from your 'flu', and compare the latest results to the last two or three values.
Secondly, as your question suggests, you had a much greater decline in your CD4 cell count than would be expected by a simple virologic failure. In general, a virologic failure will be accompanied by an average decline in CD4 cells of 100 cells per year. In your case, you are describing an abrupt CD4 cell decline of 328 cells over a period of 4 months, during a time when your measured viral load was undetectable.
Finally, as you point out, you feel good and you are still gaining weight.
Taken together, the available evidence suggests that you had a temporary lowering of the absolute number of CD4 cells (though maybe not the percentage of CD4 cells to all lymphocytes) due to the 'flu' that you suffered, and the best course at present is to stay on your current regimen and repeat the CD4 and viral load tests promptly.
I suggest that you take this email response with you and talk to your doctor.
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