My numbers are going down more and more.

Question

I was diagnosed with HIV last year. My numbers are going down, my last lab had my doctor giving me a perplexed look. 10/25/08 Revealed: Absolute CD4 Helper 708 %CD4 Pos. Lymph 32.2% 2/11/09 Revealed: Absolute CD4 Helper 773 %CD4 Pos. Lymph 36.8% 6/20/09 Revealed: Absolute CD4 Helper 638 %CD4 Pos. Lymph 29.0% 9/21/09 Revealed: Absolute CD4 Helper 456 %CD4 Pos. Lymph 25%

The kicker is that my viral load shows me to be undetectable. Should I be worried about my T-cell counts? Shouldn't my viral load be goofed up? I am scared and confused and my doctor doesn't seem to know what is going on.

Answer

Thanks for your question.

I am assuming that your are on ARV treatment. People who have undetecatble viral loads without medication (called "elite controllers") can have drops in their CD4 counts because their immune system is revved up against the virsus even though the levels are too low to measure.

If you are on meds and suppressed the trends are less clear cut. Sometimes it means that there is something that is causing the immune system to be stimulated..this could be a chronic infection such as herpes or CMV, or perhaps tuberculosis or some other related infection. Occasionally lymphoma and other conditions that effect the lymph nodes can cause this. It would be worthwhile looking for signs of a chronic infection. This could be done through blood tests , skin tests or scans. Although you have 3 readings in a row heading down, many times the next one will be up...this is also common. Do not be discouraged. Keep up with your treatments and follow through with the next measurements.

Best,

Joe