consistently low CD4 count but undetectable. any insight?

[wood]

So I met a guy the other day and we hooked up. Great guy, and fun to talk too. So he knew I was neg, and I knew he was HIV+ undetectable. He has been HIV+ for about 6 years, and went on treatment within a year of and a half of initial infection. What was interesting is that he said that he has a consistently low CD4 count, despite being undetectable for years. He said his was always in the range of 250-400, but he rarely gets sick, and never misses his medication.

I know this isnt a medical forum, but anyone with insight into what could cause this? I know CD4 counts will always vary from person to person, and that 500-1000 is considered normal. Would this be a situation where HIV is still the root cause of a low CD4 count or is it just natural for him to be lower.

[fillmyholeftl]

I have a few friends who also have consistently low CD4 readings. As long as its not dropping...its generally not a problem. The % can be a better indication of overall immune health in them.

I'm reading your mind.... It really isn't any indication of more "toxicity" or transmission issues.

[wood]

I have a few friends who also have consistently low CD4 readings. As long as its not dropping...its generally not a problem. The % can be a better indication of overall immune health in them.

I'm reading your mind.... It really isn't any indication of more "toxicity" or transmission issues.

Haha, Nah, I already knew that, Im not worried. I only realized that is how the post came across after I couldnt edit. It was more of curiosity thing. He seemed a bit subconsciously worried about it, but i told him for some people it could be normal.

[pozpig]

I've always been told that 8-1200 was considered "normal for healthy individuals", however that said, it does vary significantly from person to person (healthy even). I agree that the CD4% is a far better indicator, and generally doesn't fluctuate as wildly throughout the day as the cd4 count. In my initial years of living as poz (about the first 5 or so) my numbers were consistently low, starting off at 221 at my initial test, dropping down to 140 and staying below 200 for the best part of a year, and gradually breaking each century mark about every two years thereafter. At the time I was taking Zerit (nasty stuff!), Epivir, and Sustiva. After getting off that combo and moving to Epzicom and Sustiva, my cd4 count skyrocketted to the 700's within a couple months. Until that change, I barely broke 300 on my cd4 count. That said, it may be possible that the meds are the cause for the low cd4 count. Unfortunately without making a med change to confirm, I'm unable to say for certain that the meds are the direct cause. However, as stated earlier, as long as there isn't any illness involved, having a low cd4 count isn't something to get overly worried about. As long as the cd4% isn't abnormally low (should be in the 30% range) and viral load is undetectable, I'd say you're doing a pretty good job at keeping the virus under control. Bottom line, if your bud has his virus under control, there should be little to worry about. It's possible that his immune system, although doesn't have the higher cd4 count that is defined by "normal", is sufficient for his body.

[bearbandit]

250 - 400? I've lived most of my adult life in that range. And yes, I've had a few aids-defining illnesses (last one was about six years ago and my fault: you don't feel sick lambs without using Universal Precautions!. As others have said it's the percentage that's more important, the numbers of cells is less reliable and varies from country to country. Personally I wouldn't consider 250 - 400 as unusually low, just a warning to watch out for thrush: below 350 I tend to get genital thrush (in common with many people with diabetes) and below 250 I tend to get oesophageal thrush - both easily cleared up with flucanazole (now try changing the the stresses on that word!). Just make sure that you're not palmed off with the the single dose version: I reckon on two weeks of 50mg twice a day to get rid of the little bastard.

[Blueyedsoul]

Great thread! This is very informative. I have a local undetectable twink bottom who has this very issue. VL under 20 and a CD4 at 300. He's highly compliant and looks to be the ideal patient. So, I seed him regularly. As a neg top I've been only recently been playing with undetectable bottoms. So far it's been great but I have had strange numbers and often question them.

[bearbandit]

250 - 400? I've lived most of my adult life in that range. And yes, I've had a few aids-defining illnesses (last one was about six years ago and my fault: you don't feel sick lambs without using Universal Precautions!. As others have said it's the percentage that's more important, the numbers of cells is less reliable and varies from country to country. Personally I wouldn't consider 250 - 400 as unusually low, just a warning to watch out for thrush: below 350 I tend to get genital thrush (in common with many people with diabetes) and below 250 I tend to get oesophageal thrush - both easily cleared up with flucanazole (now try changing the the stresses on that word!). Just make sure that you're not palmed off with the the single dose version: I reckon on two weeks of 50mg twice a day to get rid of the little bastard.

Dammit! You don't FEED sick lambs... I'm Welsh, but not that Welsh!

[wood]

He's on atripla and has been since the beginning IIRC if it makes any difference

[Poz1956]

Normal for a person under stress is 500. My recollection is that normal for healthy folk is 800-1,200 .

Staying at undetectable is the real goal, and they usually won't change the regime, unless side effects start to show up, or he needs some other medication that isn't compatable. For example, I needed a PPI inhibitor for acid reflux, so they had to change me off of Sustiva.

There really isn't any danger of anything until it gets below 200. They used to pay huge attention the the CD4 count. Now it's more the CD4/CD8 percentage that they watch. The most important thing they watch about the CD4, is the trend. Mine rollercoasters between upper and lower 400's like a sine wave. Basically it's steady, no downward spiral, so my doc is happy. You can tell you bud you know several people in the same boat, and all their doctors are happy too.

I'd be willing to bet that at initial diagnosis his CD4 was very low. It's climbed to where it is, and is holding steady. It may slowly over time increase.

I took too long of a drug holiday (back when they let us take drug holidays) after bad side effects to Retonavir. When I went back my CD4 was very low. When it stopped falling it was at 89. (Yes Bear - yet another scary parallel in our lives.) By today's definition I had AIDS. But back then you needed the low CD4 and an opportunistic infection. I never had one, so I still say I' just Poz. Once I started on meds again, it slowly grew to where it is, and seems to be staying there.

I don't know about the rest of you, but I'm glad Bear isn't into bestiality. A little kink is good, but feeling up sick lambs just isn't a good kind of kink. Besides, how would he keep a constant supply of sick little sheep so he could get his jollies. It's good that he caught that mistake.

[regenesisto]

Before I tested poz, I always had low CD4 counts, and my doctor was concerned that I had HIv or something else, so I kept getting tested for everything and still had low CD4 counts. That was my normal, and I didn't have any abnormal flus or colds or other infections. Tested poz, CD4 dropped a bit, not much, and now on meds my CD4s are back to my normal low. Some people have low CD4s. A friend of mine who's HIV neg has the same issue. It's his normal.