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Undetectable with Declining CD4s -- Any Guidance?

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Hello everyone!  I've read through these forums over the past few years but until this very moment have never posted anything.  First and foremost, I'd like to express my gratitude to everyone who contributes here -- While I have been a bit of a wallflower, these forums have helped me through some tough times and have certainly helped to educate me on living with HIV.

First a bit about myself... I was diagnosed positive a few years ago.  While my numbers at diagnosis were reasonable (CD4 427/37%, VL 11833), I elected to start treatment immediately.  For me, the pros far outweighed the cons.  Overall, my treatment has been very successful in suppressing my VL.  I originally started on Atripla but switched to Prezista/Truvada/Norvir due to the 'oh so enjoyable' fogginess that accompanied Atripla.

What brings me to the forums today is that my recent (past year) lab results seem to be showing a decline in CD4 counts and percentages despite a suppressed VL.  I recognize that my numbers will fluctuate and that I shouldn't jump to conclusions over one or two sets of labs.  However, after waiting 9-12 months to see how things would pan out, I am now starting to worry because (to me) the signs point to a downward trend.  I should point out that my total (absolute) lymphocyte counts and percentages have also been declining and have been either low or on the low end of normal (diagnosed with lymphopenia). 

I have been doing everything I can to stay healthy.  I eat well.  I exercise.  I get plenty of sleep.  And to boot, I have not missed a single dose of meds over the years.  I have been doing all that I can not to worry about my labs but I am starting to feel a bit defeated.

This prompts a few questions that perhaps you all can help me out with:

1. Am I reading too much into my labs?

2. Does anyone here have any experience with lymphopenia?  Outside of being HIV positive, my doctors and I have not been able to identify any other underlying cause.

3. Does anyone have any experiences they can share with declining CD4 counts and percentages despite VL suppression?  Could my doc and I be missing anything or trying anything else?

4. My doctor suggested that if my numbers continue to decline that we may consider switching meds.  However, with my VL being suppressed, I am having a hard time in seeing the benefit of doing this.  Your thoughts?

I certainly value the experience present throughout these forums.  Any information or guidance that you could offer would be appreciated.  Thanks.

Date    VL     CD4 CD4%
08/10 11833 427  37
11/10 15423 474  33
01/11 89       401  41
05/11 <20     473  40
08/11 <20     409  40
11/11 33       395  36
03/12 <20     579  40
06/12 <20     405  47
09/12 <20     384  44
02/13 <20     247  39
03/13 -----     246  37
04/13 <20     204  34


    Hi PFOUR2013   ,

                           I am on the same regime as you , have been on Prezista/Truvada/Norvir  for 9 ?  Months now . Was Reyetaz for 7-8 years ?

  I was horrified yesterday , My T-Cells have dropped another  70 points !
  I am now at 395  , I know that number looks good , but my % is 22 , so I have
102 good T-Cells , As I see it .

   I have been undetectable  from December 2004 .

  A few years ago I was up to  over A thousand T-Cells   .

 I really hope someone that knows what is up chimes in .


 P.s. I am not a happy camper  :'( 

Edited to say 395 T-Cells  Not 465  :-[

In my opinion, I agree with your doctor about switching to a new medication. Sometime your body reaction to the medication could be unpredictable, in your case it could be in the form of lymphopenia. It would not hurt to try, you already do everything beside changing medication. Switching while maintaining UD viral load is very safe.

Good luck and let's us know how are you doing after switching medication.


   I am sorry PFOUR2013  ,

   I did not mean to hijack  your post !!!!

   I would delete it if I could !


I am interested to see what new meds you doc suggests. A combination with no nukes (specifically no tenofovir) may help.

Good luck

- matt


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