Numbers dropping but still UD - should I be worried?

[markabz21]

Hi there,

I started HAART in October last year when my CD4 count was 320 and VL 29,000. I started on Atripla and my CD4 count jumped to 640 in November and my VL was UD but since then my CD4 count has continued to drop although I have still remained UD. My next CD4 counts were 570 then 475 and 460. I changed to Truvada/Isentress but Im still worried with my numbers declining. Why might my CD4 count keep dropping? Is this normal?

Thanks

Mark

[drewm]

Mark, you CD4 count can change for any number of reasons. It may go up and down over time. Since you have started treatment, your doc will likely focus on your VL and keeping it as low as possible, preferably undetectable. My doc says there are many things that will effect my CD 4 count that may, OR MAY NOT, have to do with HIV.

[leatherman]

I started on Atripla and my CD4 count jumped to 640 in November and my VL was UD but since then my CD4 count has continued to drop although I have still remained UD. My next CD4 counts were 570 then 475 and 460. I changed to Truvada/Isentress but Im still worried with my numbers declining. Why might my CD4 count keep dropping?

out of curiosity, why did you change meds?

irregardless of that, CD4s can change as much as 100 pts in the day with morning being the low point and evening the high point. Stress, food, exercise, etc, nearly everything can affect the count by 100-200 pts. Of course anything 400-500 and up is normal anyway - so your counts are perfectly normal over your last few tests.Of course, it's never about a test result but a trend. Your trend is just slightly down (over what period of time are those three tests? if those fall within a short time period, say 4 months of less, they still don't show much more than perhaps normal fluctuation) but still in a normal range.

It's never about how many CD4s you have but how well the ones you have work. As long as your count is over 200 things aren't too bad. the MOST important thing is being Undetectable When HIV is suppressed your immune system can recover to whatever level it's going to recover to. Since I'm assuming (like nearly all of us) you never had a baseline CD4 count done before having HIV, all we can do is assume that your count was probably in the normal range beforehand, and not abnormally high or low. The really good news is that your CD4 didn't drop >100 so it should recover quickly back to normal levels for you (which it seems to have done), as having a low cd4 nadir has been shown to hinder recovery (meaning many of those who hit say 5 or 10 cd4s may never recover to even 400).

see these threads (I searched the forums for "cd4 counts") for more information, as this topic has come up numerous times before (and probably will again LOL)
Why does the CD4 Cells Go Up And Down...
Changing time of day for labs?
Question Regarding CD 4 count???
How important is a CD4 count?

and, of course, there is the AidsMeds Lesson about cd4s - What are CD4 Cells?

there's a lot of information about CD4 counts in all those links, Mark, so I hope that helps you understand some more and feel better about evaluating your test results.

[eric48]

A very sharp rebound in CD4 when initiating the meds, is not so surprising.

I have had the same, then in my case it cooled down a bit and then takes again a positive trend.

My understanding is that, as CD4s are being killed on the front of infection, your body responds by producing more CD4 (replacements)

When the truce is signed and the meds say 'Game over', those CD4s that where on their way to the front arrived in numbers. The immune systems signals to stop producing so many CD4s so it does as instructed, thus the decline.

Later on your army rebuilds itself to the best of its ability and in order to fit the requirements (if it can). The immunologic response can therefore show a wave pattern at the beginning and then, once the tsunami has passed, the tides come back to 'normal'

At least this is the way I looked my numbers.

For other reasons, I was checked almost on a monthly basis, but, in fact, the 'standard' here is every 3 months at the beginning, then  every 6 months, some people are considering checking CD4s only on a yearly basis after being UD for a while.

The initial immunologic dynamics are not as important to you as the initial viral load dynamics (which are used to verify whether the meds work or not)

I do not see that you should worry to much about it

Eric

 

[markabz21]

I  changed from Atripla because I came out in an all over body rash that didnt go away. I persisted with Atripla for 2.5months though in the hope it would. Atripla worked though as my VL went to UC within a month and my CD4 initially rose but I was just tired of going to work everyday with blotchy leprosy like skin all over my face and hands.

Thanks everyone for the advice about CD4 counts. On a plus side although my numbers have dropped since treatment it makes sense when you consider it from an immunological response so I guess I just need to wait until they begin to rise again. My target CD4 is 700 as that is the number the UK government considers a fully recovered immune system so here's hoping my numbers are able to rise to that level as it will mean less worrying about infections or anything HIV related in the future.

I was also quite lucky as I had a baseline CD4 count done prior to becoming infected with HIV as I was prescribed fumaric acid esters for psoriasis and which lower your CD4 cells. Prior to starting my CD4 numbers in the 800s and after I finished on the esters they were down to 500 and I became infected with HIV in 2007 so I guess there is still some time to go before they are back in the 700-800 range.

Mark

[Matt39]

Mark, there is no 'target' for CD4 numbers and the percentage is far more important.  The government by the way has no involvement in any kind of medicine. In your case it is the BHIVA (British HIV Association) who set treatment guidelines.

Every individual is different, and even a pre-diagnosis CD4 count is irrelevant since there is literally no way of knowing whether that was at or near your average.
You need to refocus on your actual health and what your body is telling you.
If you get too bogged down about reaching some magic CD4 number, then you are simply setting yourself up for a fall if you don't.