CD4 count is falling to below 200 but viral load undetectable ...what to do?

Question

Hello. My husband was diagnosed with AIDS about 3 years ago. He has been on Atripla for about 2 1/2 years. His viral load has been undetectable since he has been on Atripla, but his last two visits to his doctor, his CD4 count has gone down (200 to 180 to 160). His doctor says not to worry, but what does this mean for his long term health? Is he more likely to become ill? If the CD4 count continues to decline, is it likely that his viral load will eventually be detectable? Also, his doctor felt that Atripla is the most effective medication for someone with HIV/AIDS, so if my husband's health declines what is the next step? Thank you for your time.

Answer

Another important number to follow is the CD4 percent, which is a more stable number over time. If the CD4 percent is not falling, then I am less concerned. You also need to check the white blood cell count (WBC) and total lymphocyte count. If they have fallen recently, but the CD4 percent is stable, then this may not be an actual CD4 decline. Atripla is an excellent drug and again I have less concern unless the viral load becomes detectable.