CD4 - CD4:CD8 - CD4 keeps going down and doc says don't worry. It will not do any good.

Question

I am on atripla, since 10/19/2009. I have never missed a dose, my CD4 count went up for awhile and has been decreasing for the past year. (see lab results below.) The doctor I see is busy and really answers in very short nondescript answers. I am not a stupid guy, but; frankly I'm lost.

Doc, always says, you are doing fine. Don't worry about the CD4 counts your viral load is and has been undetectable. What am I doing wrong? Should I be switching medications?

The CD4:CD8 is creeping up. Is that a good thing or bad thing?

The CD4:CD8 Component CD4:CD8 Ratio Standard Range 11/2/2011 0.33 3/7/2012 0.36 6/18/2012 0.39 7/20/2012 0.30 12/17/2012 0.54 3/21/2013 0.45 6/24/2013 0.52 9/10/2013 0.62 12/26/2013 0.51 2/14/2014 0.55

The CD4:

Component Absolute CD4 Standard Range 11/2/2011 278 3/7/2012 297 6/18/2012 209 7/20/2012 262 12/17/2012 163 3/21/2013 292 6/24/2013 377 9/10/2013 346 12/26/2013 287 2/14/2014 249

Component CD4 Helper T Standard Range 11/2/2011 19 3/7/2012 19 6/18/2012 22 7/20/2012 17 12/17/2012 26 3/21/2013 23 6/24/2013 26 9/10/2013 28 12/26/2013 25 2/14/2014 26

Answer

I actually would agree with your doctor. Thanks for sending the detailed information. In general, your CD4 count has remained stable over the last 3 years at an average of around 276, although the CD4% has increased significantly (7% increase), which is a good thing. the CD4 count tends to fluctuate more and can change because of time of day, stress, other ongoing infections, after immunizations, among other reasons. The CD4% is a more stable number over time, and given the CD4% and CD4/CD8 ratio increases, indicates your immune system is getting better. Given the consistently undetectable viral load and these numbers, I would not recommend changing HIV treatment regimens.