I recently had extensive surgery on my foot. It included a transplant from a bone bank, the placement of two screws in my ankle and several other repairs. I've been in a cast for ten weeks. For the past two years my CD4's have stayed around 400 consistently. Several weeks after my surgery they fell to 275. I'm considering starting HAART based on the result (my VL is <2000) but wonder if the surgery could've affected the results and there's a possibility they will bounce back.

Surgery, acute illnesses and the like can lower your CD4 count temporarily. This is due to a genralized reduction in your lymphocyte count, that also affects the CD8 cells in a similar manner. Given that the CD4 and CD8 count are affected in a similar manner, the CD4 percentage remains unaffected. Over a number of weeks, things usualy go back to how they were before the operation.

For you, I would look at the CD4 percentage. If it is not changed, the reduction in CD4 count probably does not represent progression of your immune disease and I would probably hold off on starting HAART, at least until you have had a chance to repeat the counts (and percentages) in a few weeks.