Dear the good Doctors, I have been diagnosed and on haart for two years now. At first my cd4 count was only 15 and since starting meds (sustiva and kivexa) i have been unable to get my count over 100 @ 5%. My viral load has remained undetectable and I have never been ill as a result of being poz, so why i am struggling to get above cd4 200? Should I try different meds? or will I always have a low cd4 count and %?

The lower the CD4 count when starting effective HIV therapy (HAART) the more likely it is that some patients will not experience the expected CD4 recovery. Age, loss of thymic function, ongoing immune activatio in the gut, loss of lymph node architecture, genetic and other factors can also influence rate of CD4 recovery. For an individual patient it can be difficult to know with any certainty which of those factors are active. I have had a number of patients who only very slowly recovered their CD4 count. A few others have simply been stuck at a low CD4 count but generally are still doing OK clinically on HAART (still recommended to continue ART). We are awaiting the results of a large trial (SILCAAT) that is looking at whether boosting CD4 counts with IL-2 results in a clinically meaningful benefit. KH