Hi Bob:

I was on medication (Atripla) since March 2008. It took me 5 months to get my VL undetectable. But I dont really understand my test result: in July, my test result: VL 289 CD4 435 19%, in August my test result shows undetectable VL with CD4 345 20.5%. My question: Why my CD4 dropped after VL become undetectable. I could not get proper answer from my current doctor, they kept saying I am fine without any explaination and my doctor seems like consistantly busy.

Is that normal? Thanks and I am very worried.

Best regards Mark

Hello Mark,

The absolute CD4 cell count tends to bounce around, due to many factors in addition to HIV. Anything that affects the total white blood cell count will also affect the lymphocyte count and thus CD4 cells (a subset of lymphocytes). The more accurate parameter to monitor when it comes to CD4 cells is the CD4%. This parameter is much less sensitive to the various conditions that alter absolute CD4 cell counts. Your CD4% rose from 19% to 20.5% as your HIV plasma viral load fell to undetectable levels. This is what we would expect (and hope) would occur. Continue to monitor your counts every three-four months. The longitudinal trends will become more obvious. If your HIV plasma viral load spikes upward (above the 500-1,000 range), consider getting a resistance test (genotype/phenotype) to ascertain if you've developed resistance to one or more of your current antiretroviral agents.

Good luck.

Dr. Bob