Is this normal cd4 fluctuation?

Question

Hi Dr. Handsome,

Is it possible for a CD4 count to DROP more than 100 points despite having an undetectable load? So here's what's been going on:

1/14/13 - CD4: 319 VL: 12,111 (started Atripla) 2/1/13 - CD4: 401 VL: UD 2/28/13 - CD4: 457 VL: UD 5/2/13 - CD4: 521 vl: UD 8/8/13 - CD4: 460 vl: UD 8/29/13 - CD4: 467 vl: UD 11/14/13 - cd4: 450 vl: UD 2/1/14 - cd4: 390, vl: UD

Is there something serious going on between 8/8/13 - 2/1/14? It seems weird that my viral load is undetectable, but my cd4 is decreasing rapidly. Is there another undisguised ailment that might be causing this? I would consider myself a healthy man, so maybe it's just something I'm not noticing.

Thank you

Answer

I am not concerned, given the consistent undetectable viral load. The CD4 count can vary depending on time of day, stress, after immunizations, because of other ongoing infections or medical conditions, different labs performing the test, among other situations. Another number to follow is the CD4 percent, which is a more stable number over time. I suspect the CD4% has been pretty consistent.