Question

Hi there. My partner was diagnosed a little over three months ago...CD4 was 46, VL was 450,000,and absolute CD% was 10.5%.

Began treatment about two months ago (took a month for phenotype results to come back), and a month after starting treatment, CD4 tested at 180, with a VL of 660 and a CD4% of 12.2%.

Today, another month on, CD4 was at 204, with a CD4% of 9.7%. Still waiting on the most recent viral load. He's on once-daily Atripla.

While we're happy with the increase in CD4, and the drop in viral load, we're a little concerned about why the CD4% is dropping, and not increasing. Will be asking our infectious disease specialist when we see him next week, but just wondering if you have any thoughts, and if we should be concerned.

Thanks so much for all you do!

Answer

Hello and thanks for your post and kind words.

While the decrease in CD4 percentage isn't in the right direction, it seems that overall things are tracking the right way. First, a baseline CD4% of 10 would predict that the absolute CD4 should be around 140 (rather than 46), this prediction makes the current shift to 204 less in magnitude; actually in keeping with the general expectation that while viral loads respond quickly to treatment, CD4s are slower.

It might be worth asking if your partner's on any medication that might suppress white blood cell counts (like Bactrim, as he should be) and if that could have an effect on the percentages and counts.

I know that doesn't entirely answer your question, but if all else is going ok, I'd be patient. I suspect that the numbers will definitely improve over time.

Best, BY