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Low CD4s From the Onset of HIV Infection
Oct 7, 1997

Before I tested positive for HIV in June 1994, I was receiving HIV antibody tests every 4 to 6 months (because I realized I was in a high-risk group). My last negative test was in December 1993. However, when I tested positive in June, I had a CD4 count that was already relatively low (320). My doctor at the time believed that, because I was showing signs of "seroconversion sickness," my CD4 count would probably rebound over time, especially with aggressive treatment. Although my CD4 count did rise into the 600s for a time with treatment, they eventually settled back down and have remained fairly steady in the upper 300s. My last viral load test (last month) was undetectable. Is it possible I had a low CD4 count even before I contracted HIV? If not, why is it that my CD4 count was so low so soon after I contracted the virus and has never risen to normal levels -- even with aggressive treatment (especially considering my undetectable viral load)? Thanks for taking my question.

Response from Mr. Sowadsky

Hi. Thank you for your question. There is actually no simple answer to this question. CD4 counts can be highly variable. This is why we look not only at absolute CD4 counts, but also trends in these counts over time. We also look at CD4 percentages, which tend to be less variable from test to test. If your CD4 count is remaining relatively stable (or modestly increasing), this is clinically good news. We become most concerned when the CD4 count progressively decreases over time, or if it goes to very low levels (especially if it falls below 200 or below 14%, indicating a severely damaged immune system).

It would be very unusual for a person to have a low CD4 count without having HIV, or other problems with the immune system. If you were recently infected, there could be several reasons why your CD4 count is already low. You may have a more aggressive strain of the HIV virus. You may have other health problems that can make your HIV infection more severe. Because this disease can vary greatly from person to person, in some people the disease progresses very slowly; in others, it progresses much quicker.

Your CD4 count tells us the status of your immune system today. The fact that your viral load is very low, is very good news. This tells us that we can expect the rate of decrease of your CD4 cells, to slow down or stop. When the viral load is low, we can predict that further damage to the immune system in the future will be small. When the viral load increases, we can expect damage to the immune system to become more severe in the future. In other words, CD4 counts tell us how you are doing now. Viral load tests predict how you will do in the future . Further testing of both your CD4 cell count and your viral load are important to see how you are doing clinically. Generally, we do these tests every 3-6 months. However, if there are significant changes in your clinical status, your doctor may choose to do these tests more often.

In summary, this disease progresses at different rates in different people. Because there are many variables as to how fast the disease will progress in people, there is no simple answer to your question. Your CD4 count indicates that you already have damage to your immune system. However, if you respond well to treatments, have an optimistic and positive mental attitude, and take good care of yourself, you could potentially have years of high quality life ahead of you. If your viral load remains low, we can also predict that you should do well in the future. Further CD4 cell counts and viral load tests will be necessary to see if your treatments are successfully slowing down the disease or not.

If you have any further questions, please feel free to e-mail me at "nvhotline@aol.com" or call me at 1-800-842-AIDS (Nationwide). I'm glad to help!



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