I was diagnosed in 2002 and have been taking Trizivir and Sustiva. My viral load went undetectable almost immediately. My original cd4 count was around 100. After 4 years now, my viral load is still undetectable (or supressed) but I just can't seem to get my cd4 count to go up to the other "acceptable levels" i read about. During these four years the cd4 count has been very slow to rise (consistant but slow) and is now only about 250-270 range. Why is this? Should I change drug combinations or just stay with the status quo. My doctor says that CD4 counts really aren't that important and that keeping the viral load undetectable is the important factor. So should I just be happy with this situation or should I insist on maybe looking into more effective drug treatment to get the CD4 count up. I would be thrilled if it would just get up around 350 or something, but I just can't seem to get there. I feel fine and am healthy, but I guess I'm just concerned about what level my cd4's should be by now. What do you think?

One of the intriguing observations we have all made is the variability seen in the increase in CD4 cells in those on effective therapy. There are many potential explanations for why this happens but most of the time there is little one can do about it. The good news is that our collective experience in the field is that most people with undetectable viral loads, regardless of CD4 cells do not become ill. It is for this reason that I would agree with your provider and not necessarily rush to do anything different.

It is worth noting that you will occasionally hear that CD4 cells increase more in those taking protease inhibitors than NNRTIs such as sustiva. Because of this it is not unreasonable to discuss such a change with your provider, but I am not convinced at this time that this observation is completely supported by the data. For what it is worth, in the coming weeks there will be an important study released that may provide additional insight into this issue.

Best, Eric