From UCSF School of Medicine which shows that not only should your doctor monitor your CD4 % but also the ratio of CD4 to CD 8.
"Because CD4 cells are a subset of all T lymphocytes, which are in turn a subset of all white blood cells, variations in CD4 count can occur in response to a variety of variables including concurrent infection, medications, stress, malnutrition, vitamin deficiencies, and normal diurnal variation. Often, these variables affect many subsets of lymphocytes and not exclusively CD4 cells; thus, the percentage of T lymphocytes that are CD4 positive will remain relatively stable. On the contrary, the depletion of T lymphocytes in HIV disease primarily affects CD4 cells, causing a relative CD4 cytopenia and a drop in the CD4 cell percentage. Additionally, an inversion of the normal CD4/CD8 cell ratio, which is usually >1 in non-HIV-infected individuals, may be seen with progressive CD4 cell depletion due to HIV. Thus, the CD4 percent and the CD4/CD8 ratio may help the clinician determine if a change in absolute CD4 count is due to the effects of HIV disease or to some other factor."
Many IDs these days look only at CD4%, and cannot accurately determine if a med regimen is failing or if CD4 is normally fluctuating. You really have to monitor your labs and if your cd4/cd8 ratio changes significantly or if your viral load starts trending up, your med regimen may be failing.
I went through this last year with an idiot doctor who would not see that the med regimen she prescribed for me was not producing the ratios and trends that should be seen in a successful strategy. It took my viral load shooting up to nearly 1/2 million copies and my CD4 count falling by 100 for her to order the drug resistance tests. In the meantime I got a serious prostate infection that granualized my prostate rendering it non-operational, an infection of the cholangial ducts in my liver, brain deterioration, and pancreatic damage.
I have had a high CD8 count since my first blood tests in 1995, with CD8 of around 1800 and CD4 that fluctuated between 380 and 750. Even now with meds my CD4/CD8 ratio is consistently less than 25%, with the result that I have regular drug resistance tests.
I have had HIV since September 1984 and in my opinion, doctors today are horribly trained in HIV/AIDS management. That is unless their practice is limited to HIV/AIDS management. This disease is a lot more than just meds, it also requires a doctor who knows how long term infection and HAART/ART treatment effects the body.
My heart condition, liver damage, brain damage, prostate shutdown, and sun sensitvity are all due in large part to my two decades plus infection and eleven year experience with AIDS meds.
Goodness, I don't mean to sound bitter, but if you trust your doctor to render quality care individualised to your needs, you have to at least know how to read your labs and question your doctor's decisions. Most HMO and public clinic docs are pill pushers in thrall to the drug companies.
Demand quality health care and if you don't get it, be a bitch until you do. You'll live longer.
Life is a river.