undetectable and low CD4
Nov 12, 2009
Response from Dr. Frascino
The degree of immune reconstitution, as evidenced by increasing CD4 counts resulting form effective combination antiretroviral therapy, varies considerably from person to person, and is incompletely understood. For some folks, as the HIV plasma viral load declines to undetectable levels, the CD4 counts skyrocket back into the "normal" range. In other folks the degree of reconstitution is much less robust. There are many confounding variables that can influence the degree of recovery.
Your antiretroviral therapy is effective virologically (driving your HIV plasma viral load to undetectable levels for the past three years); however, immunologically, your CD4 count is stuck below 300. You don't mention your CD4 nadir (lowest CD4 count). If your CD4 count was very, very low before you began treatment, it's possible you may not climb above the 300 mark.
Your HIV specialist should thoroughly evaluate you to see if there is any other potential causes for your persistently low CD4 count in the face of an undetectable viral load. If no cause can be determined, you could try switching to an alternative combination regimen that incorporates one of the new novel drugs, such as an integrase inhibitor or entry inhibitor, to see if this makes a difference.
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