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undetectable vl, cd4 below 200
Jan 2, 2002

my cd4 has been above 200 up until 4 months ago when i got a bladder infection it dropped to 189 and this month rechecked ,it has dropped to absolute 152.percent 9.my viral load is still undetectable though and has been for over 2 years now.i am not on any antivirals inspite of my doctors persistance.i have an AIDS diagnosis from 3 years prior when i was hospitalized for candiosis -i have not had any complications other than persistent sore muscles.i was also diagnosed with systemic lupus 13 years ago but now they tell me i have AIDS. they say i do not have lupus now. how could it just go away? is it possible i had hiv to begin with? could i have both?Do you know of any correlation between the two? my monocytes were elevated at 13 this most recent cd4 count.i keep telling my doctor the cd4 will rise i am confident the bladder infection caused this decline could you justify my confusion please?

Response from Dr. Aberg

Unfortunately I do not have any clear answers for you. Someone would need to review all your medical records to figure out if you had a false positive test for lupus or if you do have lupus. Lupus is diagnosed by fulfilling certain criteria which include clinical manifestations and serology tests consistent with lupus. Without knowing what your signs, symptoms and laboratory tests were (are), I cannot say if you have lupus or not. True remissions (meaning the disease is not active and does not cause any symptoms and does not require treatment) occurs in less than 10 percent of people with lupus.

It is possible that you did in fact have primary HIV infection and had a false positive test on one of the lupus tests13 years ago. The question is whether you were tested for HIV at that time and if a follow up HIV test was done several months later. Remember that in primary infection, the HIV antibody test would not have been positive and we did not have HIV viral load testing so making the diagnosis of primary HIV infection was difficult 13 years ago.

The next question is could you have lupus and not have HIV? Again without knowing all the labs and your symptoms, I cannot answer this. Lupus can give a false positive HIV test done by ELISA. But if your western blot had multiple bands positive and you have had detectable virus, then this would be unlikely. Have you ever had detectable virus? Have you had an ultrasensitive PCR or bDNA that can measure below 50 copies/ml blood? Where do you live? Did you acquire HIV outside the US or from someone who initially acquired virus outside the US? Some strains of HIV may not be measured by the type of viral load testing we routinely use and your blood may need to be sent to a reference lab. Again without knowing specific details, I cannot answer your questions.

I can tell you that infections may lower the absolute CD4 count at the time of infection. Some infections may actually do the reverse and increase the CD4 count. The percent is usually a more accurate reflection of your immune status but it is best to repeat the CD4 count after the infection clears. I also would be concerned about you not being on any antiretrovirals (ART) with a CD4 count below 200 especially with a percent of 9. It is true that some people will live for years with low CD4 counts but you are clearly at risk of acquiring opportunistic infections. If you are dead set on not taking ART, I encourage you to at least take the antibiotics to prevent infections such as sulfa/trimethoprim to prevent Pneumocystis carinii pneumonia.

Too much missing information for me to be much help. You should ask your doctor to go over all your records so you can understand what is going on and learn more about HIV. You need to clarify how you were diagnosed with lupus and HIV. You may want to consider getting a second opinion from a HIV specialist in your area. If you do so, please make sure you sign a consent and get all your previous records for that person to review.


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