No increase in CD4 count after nearly 2 years of treatment

Question

Diagnosed in May '07 (CD4 442/34%; VL 5,830). After CD4 count dropped to 279/31%; VL 15,000 in Dec. '07, I started taking Atripla in February '08. Since beginning treatment, results were as follows: 4/08 (CD4 605/42%; VL 174); 5/08 (400/33%; UD); 8/08 (323/32%; UD); 10/08 (367/35%; UD); 1/09 (381/36%; UD); 4/09 (377/39%; UD); 7/09 (366/39%; UD); 11/09 (344/37%; UD). I am 45 years old. Is treatment working? Am I developing resistance? Why hasn't CD 4 count increased? Concerned CD 4 count is still not within "normal" range after approximately 18 months of treatment. Would you recommend any change in treatment? Thanks very much for your advice.

Answer

The Atripla is working, given your repeated undetectable viral loads. HIV drug resistance is not a factor here. I would not recommend any change in therapy. Yes, although your CD4 count is not in the normal range, your CD4% is. I would suspect that your total white blood cell count (WBC) or total lymphocyte count are somewhat decreased, thus affecting your CD4 count and not the percent.