Undetectable but CD4 has decreased twice. Normal or not?

[Gambit]

If this has been posted I'm sorry.. but I'd really like advice.  I've been googling on my phone all day looking for answers.  Is it normal for a CD4 count to drop by a significant amount two times in a row?  I've been on Atripla for about a year now, I'm undetectable, but my CD4 is way below what it used to be.  In July it was 798, October it dropped to 570, now as of Dec 14th its down to 446 (my % was 39).  My nurse leaves me a voicemail with my results when they come in and she acts like its no big deal at all (and my Dr did too when I asked about the drop to 570).  But in the voicemail she said that my CD4 is below normal and that 490 is the cut off.  Why is it dropping like this?  My meds are obviously working since I'm undetectable and I've never missed a dose.

I read a lot about "blips" but they usually pertain to VL's.  Should I be stressing out over this (which I am)?  I've left a VM for my doctor but he won't be back in the office till Friday.  This result makes me think that I'm doing something wrong.

I was working out A LOT back when I was first on the meds (I was trying to lose a beer belly, which I accomplished, so now I don't do it every single day anymore).  Could that be part of it?  I'd really like some advice if I could get it, because I tend to lose sleep over ish like this.  Thank you guys.  I appreciate it!

[jkinatl2]

A person's CD4 count can vary by a hundred points in a single day. Assuming you are having your blood drawn at the same time every day and under pretty much exact conditions (fasting, etc) then you really are within the variable boundary.

Of course, if these conditions aren't the same, then that's the issue. I have had my CD4 count fluctuate pretty wildly over a short period of time.

Your percentage is considered the more reliable reading, and it's fantastic!

And yes, working out (any changes in stress, even GOOD stress) can impact the CD4 count. As I am sure you know, working out causes minute damage to the body, which is repaired with muscle tissue. It's worth the effort, absolutely. But it is a lifestyle change, and probably why they recommend you tell a doc about it

Seriously, it looks like you are doing very well.

[franfrog]

I had the same problem but also found out that it is normal.  My vl was more of my concern and also the %.  Both of yours sound great and I would not worry about it.  Like jk said it can vary from day to day, minute to minute.  Good luck.

[Gambit]

You guys are life savers.  That's like 30 pounds taken off my shoulders tonight. 

I changed from afternoon appointments to morning appointments (can't remember when, but it might have been when I dropped to 570).  I didn't even think about that.  And I'm glad to know that my % is good.  I think when I started seeing my CD4 increase so high, it was really discouraging to see it drop.  I probably read too much into these lab numbers.  I'm glad to know this is normal.  You guys are awesome.  THANK YOU!

[Ann]

And I'm glad to know that my % is good.

Good? It's awesome!!! My percent tends to bounce between 27 and 29.

I don't have time to look it up right now, but I'm pretty sure CD4s tend to be at their lowest point in the morning. That may account for what looks like a drop. As long as your % stays steady, you have nothing to worry about. Keep up the good work with not missing doses.

[surf18]

Yep my lowest cd's were when I had blood drawn in am

[phildinftlaudy]

No worries -- your cd4% is great -
If you look at my signature block you will see that my cd4 counts had dropped for a few readings in a row - but then bounced back up....

CD4% is a much more reliable indicator.

Very best to you.

[Gambit]

Thank you guys.  As always this forum has helped me out and given me good information.  I appreciate it!!!