I found out I was HIV + May 2008. CD4 count of 702 and viral load of 1080. Chose treatment and placed on Atripla. Tested again Sept. 2008 my viral load was undetectable but my CD4 count was now 389. My doctor told me not to panic and didn't really provide an explanation of why such a drastic drop in CD4 count, suggesting one of the tests could have been inaccurate or just more time needed to see what's a good baseline for me. Ok, I am in panic mode. What do you think?

Hello,

Your HIV specialist is correct. Although he may not have explained the situation clearly enough for you. Following primary HIV infection, there can be dramatic shifts in HIV plasma viral load (it skyrockets) and absolute CD4 cell counts (they drop). Once your body's immune system kicks in, the viral load decreases and stabilizes somewhat (at least for a time) at what we refer to as the viral set point. The CD4 cell count often recovers somewhat as viral replication decreases. Effective antiretroviral medications can drive HIV plasma viral load to undetectable levels. This allows for further immune reconstitution (increases in CD4 cell counts). On top of all this, you must remember the body's CD4 cells are involved with all sorts of other germ defenses other than just HIV. Consequently, the number can bounce around quite a bit, due to intercurrent illnesses. So far, you've only had two sets of laboratory tests. That your HIV plasma viral load decreased to undetectable levels is excellent and reassuring news. This means the medications are doing what they were designed to do control viral replication. Your CD4 cell count is difficult to interpret, based on only two determinations, because if, for instance, you were recently infected, your CD4 count could have dropped prior to Atripla, suppressing viral replication. The 389 would even be on the way back up from a lower level in the June-to-August timeframe. Alternatively, the CD4 count could be reflective of an intercurrent illness. I agree you shouldn't worry about a single CD4 determination. It would have been more worrisome if your Atripla was not effective in suppressing HIV viral load.

I would suggest you peruse the information on this site related to HIV monitoring tests. You should find it enlightening and reassuring. I would anticipate you'll see a rise in your CD4/CD4% with your next blood draw, assuming your viral load remains undetectable.

Good luck.

Dr. Bob