VL way down but CD4 also dropped after 3 months on Atripla

[Condesa66]

Hi, I started Atripla shortly after seroconverion, with 510 CD4 and 1.7 million VL.  Just got my 1st results back after 3 months.  My VL has dropped all the way to 179, but my CD4 also dropped to 443. I don't see my doc for another few weeks, and am worried about the CD4.  I am 47 years old, recently infected (4-5 months).  Should I be concerned about the CD4?  And as far as my VL, how soon can I expect that to be undetectable?

Thanks!

[pittman]

Should I be concerned about the CD4?  And as far as my VL, how soon can I expect that to be undetectable?

In short, no, there is no need to be worried.

Your CD4 numbers normally will vary more than cd4% or VL. Time of day can even affect the them. The over all trend will most likely be up. Your numbers, at least those shared, look very good, and most likely your next normally scheduled set of tests will show an undetectable VL. 

These are great questions for your doctor. I kept mine quite busy explaining every "blip" on every type of test, as well as why he was monitoring all the many things he was. Fortunately he seems appreciative of the interest and more than happy to take time to explain any and everything. 

I did ask him to let me know if he was ever bored by the questions and I would find harder ones for him about the latest research articles. 

[leatherman]

510 CD4 ...dropped to 443

two things to consider
1) a cd4 can vary by up to 100 pts in a single day, so this change is not very remarkable or even out of the ordinary
2) it is ALWAYS about the trend over at least three tests and 6 or more weeks of time. Never worry about what a single test says (even if it seems "not good") but about how the trend is going.

and for good measure here's an extra thought to ponder
3) treatment is not neccesarily a straight line. Your viral load can bounce some after beginning treatment, while your cd4 will almost NEVER match the previous test results because a cd4 count is not really a very

Your viral load dropped an amazing amount from 1.7mill to less than 200 in 3 months and your immune system is clearly working to recover. With results like this so far, you should easily be UD and have a higher CD4 count by your next lab work (although without knowing what your PRE-HIV cd4 counts were there is NO way of even guessing as to how much that will or won't recover. As long as your immune system works and keeps you healthy, that's all that matters.)

so, the gist of this is that your HIV therapy seems to be working remarkably well, and you have no reason to worry - instead you should be incredibly happy with your successful therapy. WooHoo!

[Dan0]

I was on Atripla for seven years and my labs looked like the Cascade mountains...up, down, stagnant, more ups, more downs. They ranged from over 1000 several times to mid-700 range. It's just how I rolled with Atripla but the undetectable was solid from six months into the prescription to the day I stopped!

It's some powerful stuff but my ID doc said I would drive myself crazy if I took every lab as some harbinger of something bad....or good.

Good luck!

[buginme2]

The only thing that really matters is your viral load.  They are now even considering once you reach undetectable to only test cd4 once a year or even less (if needed).

One big reason for this is because it can change by hundreds of points from one lab test to the next and it all means nothing and these changes can freak patients out (for no reason). 

As long as your viral load is going down and stays undetectable once you get there your fine.

[Dan0]

The only thing that really matters is your viral load.  They are now even considering once you reach undetectable to only test cd4 once a year or even less (if needed).

My Doc said that he has most of his long term UD patients on the once-a-year CD check (including me) for the very reasons you mentioned. I checked with his nurse to see if his two other ID doctors in the practice were doing the same and they are. I miss the bi-annual results only for curiosity sake - what I'm most interested in is that it comes back UD.