Hello. My husband was diagnosed with AIDS about 3 years ago. He has been on Atripla for about 2 1/2 years. His viral load has been undectable since he has been on Atripla, but his last two visits to his doctor, his CD4 count has gone down (200 to 180 to 160). His doctor says not to worry, but what does this mean for his longterm health? Is he more likely to become ill? If the CD4 count continues to decline, is it likely that his viral load will eventually be detectable? Also, his doctor felt that Atripla is the most effective medication for someone with HIV/AIDS, so if my husband's health declines what is the next step? Thank you for your time.

Hello,

There are a number of reasons CD4 counts can decline, including: (1) "normal" variation, (2) intercurrent infection, (3) development of drug resistance. When drug resistance develops, generally we would see a spike in HIV plasma viral load. Because your husband's viral load remains "undetectable," we can assume he had not developed significant drug resistance. Consequently, your husband's HIV specialist should evaluate him for intercurrent illnesses. If no cause can be determined, a repeat CD4 count within one to two months should be considered to see if the decline is indeed a trend or was merely normal variation (CD4 counts can swing mildly up and down, due to many causes, including diurnal variation, stress and other nonspecific causes). If the negative trend continues, an alternative combination antiretroviral regimen could be considered, possibly including a protease inhibitor and/or integrase inhibitor.

Good luck.

Dr. Bob