I am hiv postive person from now about five years and i am using three types of antiviral durgs and my viralload is less than 50.But my CD4 IS still the some times less than 180 and some times 200 my question is if the viralload less than 50 then what the wrong with my CD4 to rise up? Please answer my question.Thank you!

Thank you for your post.

The CD4 response associated with viral suppression is variable from person to person. While there is considerable research looking into why some experience less of an increase in CD4 cells than others there is often no explanation. It is worth talking to your provider to see whether there are any other medications you are taking that could reduce your lymphocyte count. Similarly, there are a few HIV regimens that also have been associated with less of a CD4 cell increase than others, in particular tenofovir (Viread) with didanosine (Videx, ddI).

Short of identifying another drug that may limit CD4 cell increase there is little to do. Some have suggested modifying the current antiretroviral regimen, which may not be unreasonable if thought to be safe after discussion with your provider, but not usually necessary. In general, people with undetetable levels of virus do not become ill, particularly with CD4 cells of approximately 200 per uL. Hopefully my comments are at least reassuring if you decide to sit tight on your current therapy with continued observation. The reality is that many do experience slow but progressive increases in CD4 cells over time. The main thing is to continue to take the medications consistently and be monitored closely.

Best, Eric