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CD4 Cells Decline While Viral Load Nears Undetectable
May 12, 2005

Thank you for taking the time to participate in this forum and for taking my questions.

I am a long time survivor. Ive known that Ive been positive since the early 80s when the first HIV tests were available. Ive progressed very slowly over the years and it wasnt until September 2004, when my CD4 cells fell into the high 200s accompanied by an extremely high viral load that I began treatment for the first time.

I was on Kaletra, Viread and Epiver for 8 months and my viral load has dropped to what I am told is almost undetectable. Within six months my CD4 cells climbed to 444 / 20% and my viral load dropped to 148. However, 2 1/2 months later my CD4 cells went down to 340 / 16% while the viral load improved by dropping to 92.

My doctor tells me that this is normal and that I shouldnt worry about the drop in CD4 cells. He goes on to say that a drop in CD4 cells such as this falls into the normal range of CD4 cell fluctuations and that I should expect to see them go up and down as treatment continues.

My main question is this: If, as is commonly believed, the virus causes the destruction of CD4 cells, how does a low viral load, such as mine, still cause a CD4 cell decline?

Having agreed some time ago that I would switch to an easier regimen after 6 to 8 months of treatment, I just made the switch and am not due for blood work for another two months. Do you think that that is too long to wait? Im worried that the CD4 cells might still be dropping and could hit a dangerous low.

In considering your response, you should know that, as always, I feel fine and Im pretty much on top of my game.

Again, thank you for taking my questions.

Response from Dr. Henry

Treatment of HIV with effective antiretroviral predictably results in a significant drop in the HIV level (viral load). Recovery of CD4 cells is dependent on both a reduction in the rate of destruction of CD4 cells by HIV AND the innate and highly variable ability of the body to regenerate new CD4 cells. With age the regenerative ability declines. Some patients may have destroyed lymph node architecture making it more difficult for CD4 cells to regenerate. Many other factors may influence the recovery rate of CD4 cells even in the setting of high level viral suppression (i.e. < 50). Some studies have suggested that up to 30% of patients on effective HIV treatment may have some sort of atypical (often blunted ) CD4 recovery. Sometimes the recovery is just very slow after an initial increase. KH

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