cd4 dropped from 1000 to 500 in 3 months

[NWUSHorny]

My VL goes above 100 occasionally, it is usually in the 30-50 range and I think has only met the under 20 threshold for undetectable twice in 5 and a half years, but was over a million before I started treatment. My ID doc has been reluctant to try to change my treatment because my CD4 count has stayed in the 850-900 range and  was only below the 400 threshold while under going chemo, but even then the CD4/CD8 ratio remained in the normal range so it may not be a good measure. He has asked me about missed doses right after I finished chemo, but hasn't since and generally considers my HIV infection well under control. I would be concerned if my CD4 count dropped below 400, but would probably brush it off at 500.

[tomzefis]

5 hours ago, WillingRawVerse said:

I've had VL blips over the last 13 years. Have never been off my meds since I started. I had 3 blips while on Atripla. 3rd blip was an indication of being resistant to one of the components of Atripla. Switched to Genvoya, had a blip there, then finally on Biktarvy. No blips in VL 4.5 years on Biktarvy. As long as my doctor says my CD4 are good, usually between 275-325, and I have an undetectable VL, I'm good to go. No news is good news.

The nurse at the ID doctor I go to was the same way to my wife, then girlfriend. Treated her like shit. Very disrespectful. Told my doctor. I don't think she stayed too much longer after that.

 

Im really scared with the situation...Im overthinking....thinking about treatment failure...or resistant virus

I don't really know a lot about HIV... but is it normal to have cd4 between 275-325 like you said?? What I understand is that if you have undetectable viral load for many years, your cd4 should be High??? Am I wrong?? I mean, like I said, I don't understand a lot about cd4, Im trying to learn more!! tks

 

[ErosWired]

1 hour ago, tomzefis said:

I don't really know a lot about HIV... but is it normal to have cd4 between 275-325 like you said?? What I understand is that if you have undetectable viral load for many years, your cd4 should be High??? Am I wrong?? I mean, like I said, I don't understand a lot about cd4, Im trying to learn more!! tks

The normal healthy human CD4 count is the range between 500-1500, so a count below 500 is not normal. The goal of antiretroviral therapy is to prevent the virus from replicating itself so that the immune system can recover, but if the damage is too extensive by the time treatment begins, recovery to the normal range may not be possible. A number of factors, including age, can affect this.

I am a 9-year AIDS survivor, who started treatment with a CD4 count of 49. In nine years I have missed exactly two doses of my medication. I have been durably Undetectable for a long time, with my viral load well controlled. But in all this time, my CD4 count topped 400 only once, and it’s pretty clear that I’ll never see a normal 500 again, no matter how diligently I follow my treatment.

[BootmanLA]

2 hours ago, tomzefis said:

Im really scared with the situation...Im overthinking....thinking about treatment failure...or resistant virus

I don't really know a lot about HIV... but is it normal to have cd4 between 275-325 like you said?? What I understand is that if you have undetectable viral load for many years, your cd4 should be High??? Am I wrong?? I mean, like I said, I don't understand a lot about cd4, Im trying to learn more!! tks

To add to @ErosWired's explanation: Your CD4 count is basically your body's general immune response system for fighting bacteria, viruses, and other infections. They're not specific to fighting HIV; they're what fight off all the other things your body may contract.

What happens with HIV is that it uses your body's other cells to replicate, and untreated it eventually advances to the point that your immune system (the CD4 and CD8 cells, among others) is overwhelmed. And when that happens, things that wouldn't necessarily be able to take hold in your system can; in HIV-speak, they're called "opportunistic infections", and there are some such opportunistic infections that are rarely seen in HIV-negative people but which show up in patients with advanced HIV disease/AIDS.

Keeping the HIV under control and undetectable means it's possible for the immune system (CD4 and CD8 cells, for instance) to not have to fight so hard against HIV. In many people, then, that can mean the CD4 cells can recover to a normal level, although progressing to AIDS before treatment begins may cause some permanent damage. In @ErosWired's case, that seems to be what happened; it means his immune system otherwise is somewhat compromised (but clearly still functioning to a significant extent).

Low CD4 numbers, however, have little or nothing to do with resistant strains of HIV or treatment failure, as long as you're testing undetectable. Resistant strains of HIV are ones that aren't affected by one of the compounds in a particular treatment (most HIV treatments contain either 3 or 4 separate compounds); but another medication's compounds may be completely effective against that same strain of HIV. Treatment failure is what happens when a particular medication becomes ineffective, but again, it's possible changing the medication may make treatment work again.

What the low CD4 numbers DO mean is that you might be more susceptible to infections that a person with a higher CD4 count might not even notice. So it's best to consider it sign to be cautious, and know your body, so that when you do pick up something, you can treat it (whether with OTC medications or a prescription, depending on what kind of infection it is).

[WillingRawVerse]

On 1/9/2024 at 9:29 PM, tomzefis said:

 

Im really scared with the situation...Im overthinking....thinking about treatment failure...or resistant virus

I don't really know a lot about HIV... but is it normal to have cd4 between 275-325 like you said?? What I understand is that if you have undetectable viral load for many years, your cd4 should be High??? Am I wrong?? I mean, like I said, I don't understand a lot about cd4, Im trying to learn more!! tks

 

Initially when I was diagnosed, I was diagnosed with AIDS. Had a VL over 500k and my CD4 level was 8. So I'm happy mine stays where it's at.

[tomzefis]

hey guys. update: my viral load came out today

62 copies/ml

1,79 copies log/ml

since 2016 I was undetectable....now Im really really worried because I never missed a dose,

and now Im worried I might have infected my partner that is negative.

😞

[lower_bucks_bottom]

7 hours ago, tomzefis said:

hey guys. update: my viral load came out today

62 copies/ml

1,79 copies log/ml

since 2016 I was undetectable....now Im really really worried because I never missed a dose,

and now Im worried I might have infected my partner that is negative.

A viral load of 62 is still considered "undetectable" and non infectious. The partner study used 200 as their definition. The term "undetectable" is really obsolete. There are tests that can detect a viral load of 1. In the US, Quest Diagnostics uses a test that goes down to 20 so <20 is "undetectable". Labcorp uses a test that goes down to 40 so to them <40 is undetectable.  A reading of 62 is usually considered a 'blip". I have been "undetectable" since 20212 but every couple of years I have a blip. In 2020 I had a reading of 138, 2 months later it was 41 and 3 month later it was  <20 and stayed that way since. I chalk the 138 to my doing the blood draw right after I had my flu shot and that can cause a blip. Your Dr should test you again in a couple of months to make sure is isn't trending up but you and your partner should have nothing to fear from a value of 62.

Edited January 12 by lower_bucks_bottom

[tomzefis]

9 hours ago, lower_bucks_bottom said:

A viral load of 62 is still considered "undetectable" and non infectious. The partner study used 200 as their definition. The term "undetectable" is really obsolete. There are tests that can detect a viral load of 1. In the US, Quest Diagnostics uses a test that goes down to 20 so <20 is "undetectable". Labcorp uses a test that goes down to 40 so to them <40 is undetectable.  A reading of 62 is usually considered a 'blip". I have been "undetectable" since 20212 but every couple of years I have a blip. In 2020 I had a reading of 138, 2 months later it was 41 and 3 month later it was  <20 and stayed that way since. I chalk the 138 to my doing the blood draw right after I had my flu shot and that can cause a blip. Your Dr should test you again in a couple of months to make sure is isn't trending up but you and your partner should have nothing to fear from a value of 62.

thank you...but what scares me is that I have 62 now, after years UD....and at the same time, my CD4 is 500.....and it as always >800....so its strange that now I have a "blip" and my CD4 got very low compared to previous 800/1000.

so Im wondering if before this blip something else happened ( like drug resistance or treatment failure )

[hairyone]

On 1/8/2024 at 9:55 PM, hairyone said:

On 1/8/2024 at 5:27 PM, tomzefis said:

cd4/cd8 for me is 0,45 today

 

You're doing fine.  It sounds like your whole body is under general stress from flu, or minor infection, or just plain worn out (too many holiday parties?).  Get some rest and take some extra care of yourself for a couple of weeks. 

I apologize. I did the cd4/cd8 calculation backwards.  This should be at least 1.0.  Your immune system is under stress.  It's probably a normal blip due to many possible normal things.  

First, relax.  You are working with your doctors and you will be ok. 

Remember, the HIV meds are not a cure.  It is only to "help" you manage a lifelong, chronic disease from a virus that is trying to kill you.  The rest is up to you.  You need to take some time out to take care of yourself.  Reduce stress, eat right, get rest, avoid drugs and alcohol.  You don't have to cut out those things forever; everything in moderation.  But, right now, you need to be extra careful until your body recovers from whatever it is fighting.  

 

 

[EuRawBull]

4 hours ago, tomzefis said:

thank you...but what scares me is that I have 62 now, after years UD....and at the same time, my CD4 is 500.....and it as always >800....so its strange that now I have a "blip" and my CD4 got very low compared to previous 800/1000.

so Im wondering if before this blip something else happened ( like drug resistance or treatment failure )

I'm going to ask a few questions that only a handful of doctors know to ask and only a handful of patients would answer honestly.... How many loads are you taking on a regular basis? Is your partner a man or a woman? (If you are a top and not using protection and finish inside, for your peace of mind, avoid cumming inside your partner for a while.) Are you having any issues at work, or at home, causing you to be under stress?  Have you changed your eating habits? have you travelled more in the last months? are you using poppers? Did you change the brand of poppers? are you having any dental issues? A simple tooth infection can cause your CD to vary, and depending  on the infection, it may affect the results. Are you doing other drugs? have you been exposed to covid? (with the infection rates going up worldwide, i wouldn't be surprised if you had an episode of covid infection, undetected, and that's what may be causing the viral load to go up.

The reason for all these questions is to determine the root cause of the blip. A drug resistance or a treatment failure as you call it is unlikely in the absence of other co-factors after all these years. 

As other have mentioned, different labs use different standards for detecting the viral load, including different techniques. Each reagent batch can be slightly different than others due to manufacturing process, which although all producers try to adhere to a Six-Sigma defect, there is no telling if a batch is slightly different unless someone complains. 

Try to put things into perspective.... When someone tests positive for HIV, most tests would also 'detect' a viral load in the range of tens of thousands to over a million copies. So when you compare your VL of 62 with someone whose VL is 875,925. I think you can rest assured that you are still in the UD range. Of course, the lower the number the better. But variations of that scale are not a concern. Any VL below 100 should be safe. 

 

 

[onlyraw]

Also - was this test on a normal testing schedule for you? Or was it at a different time of year for you?

back in the early 2000’s when I was getting tested quarterly and tge did both the viral load and CD4 each time … … my CZd4 would slowly climb during the year and then in my January test (right after the holidays with my family) it drop - frequently by almost 50%… 

so it could be a bad test

it could be just a weird drop based on stress (or as EuRawBull mentioned) an unrecognized case of Covid)

tge main thing is it sounds like you have a great dr … so what ever the case it sounds like you have the medical team to find out what happened and what tge fix is (and remember if unfit is a breakthrough… there are now lots of options to deal with HIV now

good luck!!

[tomzefis]

On 1/12/2024 at 3:18 PM, EuRawBull said:

On 1/12/2024 at 3:18 PM, EuRawBull said:

I'm going to ask a few questions that only a handful of doctors know to ask and only a handful of patients would answer honestly.... How many loads are you taking on a regular basis? Is your partner a man or a woman? (If you are a top and not using protection and finish inside, for your peace of mind, avoid cumming inside your partner for a while.) Are you having any issues at work, or at home, causing you to be under stress?  Have you changed your eating habits? have you travelled more in the last months? are you using poppers? Did you change the brand of poppers? are you having any dental issues? A simple tooth infection can cause your CD to vary, and depending  on the infection, it may affect the results. Are you doing other drugs? have you been exposed to covid? (with the infection rates going up worldwide, i wouldn't be surprised if you had an episode of covid infection, undetected, and that's what may be causing the viral load to go up.

The reason for all these questions is to determine the root cause of the blip. A drug resistance or a treatment failure as you call it is unlikely in the absence of other co-factors after all these years. 

As other have mentioned, different labs use different standards for detecting the viral load, including different techniques. Each reagent batch can be slightly different than others due to manufacturing process, which although all producers try to adhere to a Six-Sigma defect, there is no telling if a batch is slightly different unless someone complains. 

Try to put things into perspective.... When someone tests positive for HIV, most tests would also 'detect' a viral load in the range of tens of thousands to over a million copies. So when you compare your VL of 62 with someone whose VL is 875,925. I think you can rest assured that you are still in the UD range. Of course, the lower the number the better. But variations of that scale are not a concern. Any VL below 100 should be safe. 

 

 

Loads from my partner. And that happens I would say twice a month.

I have been to a lot of sex parties but I never had a lot of opportunities to get fucked… So I would say I got fuck like probably 10 times a month by different guys….and probably got 3-4 loads in 6 months.

Im a bottom gay man.. ......lot of traveling lately.

Lots of poppers ( poppers really affect cd4? I could not find a confirmation). Everyday. I would masturbate sometimes 3x a day with poppers….I changed from "Rush black"(?) to  "Fist "recently

Other drugs: I tried “G”??? And some type of “cigarette” for the first time like 1 month ago in Berlin…..but that was only 1 time

Covid? I wouldn’t be surprised if I had…. To be honest Im feeling “sick” since Christmas… like I did not have fever , but I had a lot of pain in my body, weakness and took a lot of ibuprofen….its been like 3 days that Im not having those symptoms

However today I found red “balls” in my hand ( syphilis???...but VDRL is negative ). also my Cytomegalovirus IgM ( acute infection ) came out today and it is reagent.

 

On 1/13/2024 at 12:38 AM, onlyraw said:

Also - was this test on a normal testing schedule for you? Or was it at a different time of year for you?

back in the early 2000’s when I was getting tested quarterly and tge did both the viral load and CD4 each time … … my CZd4 would slowly climb during the year and then in my January test (right after the holidays with my family) it drop - frequently by almost 50%… 

so it could be a bad test

it could be just a weird drop based on stress (or as EuRawBull mentioned) an unrecognized case of Covid)

tge main thing is it sounds like you have a great dr … so what ever the case it sounds like you have the medical team to find out what happened and what tge fix is (and remember if unfit is a breakthrough… there are now lots of options to deal with HIV now

good luck!!

My last test was in MAY.  so it was 7 months ago. Usually I test every 6-8 months. Im living in Germany and I kinda never went to a doctor in Germany, so I went last week in my home country...

[ErosWired]

2 hours ago, tomzefis said:

I changed from "Rush black"(?) to  "Fist "recently

Although there is some variation of content abroad, in the United States virtually all poppers are the same active substance, isobutyl nitrite, and many of the various “brands” are in fact produced in the same facilities, sometimes from the same batches, simply with different labels. The only difference between the bottle regular poppers and the bottle of ‘extreme’ poppers is the label and the amount of money you pay for the exact same product. Your Rush Black and Fist are likely the exact same thing, possibly with something added to change the odor. Read the teeny-tiny text on the label - it should list the active ingredient.

[EuRawBull]

6 hours ago, tomzefis said:

Loads from my partner. And that happens I would say twice a month.

I have been to a lot of sex parties but I never had a lot of opportunities to get fucked… So I would say I got fuck like probably 10 times a month by different guys….and probably got 3-4 loads in 6 months.

Im a bottom gay man.. ......lot of traveling lately.

Lots of poppers ( poppers really affect cd4? I could not find a confirmation). Everyday. I would masturbate sometimes 3x a day with poppers….I changed from "Rush black"(?) to  "Fist "recently

Other drugs: I tried “G”??? And some type of “cigarette” for the first time like 1 month ago in Berlin…..but that was only 1 time

Covid? I wouldn’t be surprised if I had…. To be honest Im feeling “sick” since Christmas… like I did not have fever , but I had a lot of pain in my body, weakness and took a lot of ibuprofen….its been like 3 days that Im not having those symptoms

However today I found red “balls” in my hand ( syphilis???...but VDRL is negative ). also my Cytomegalovirus IgM ( acute infection ) came out today and it is reagent.

 

My last test was in MAY.  so it was 7 months ago. Usually I test every 6-8 months. Im living in Germany and I kinda never went to a doctor in Germany, so I went last week in my home country...

Hi @tomzefisThere are some red flags there already, which every single one by and in itself is unlikely to cause serious concern, but you have a number of co-factors:

1.  You are saying you went back to your home country. If any of your female ancestors on your mother side are of Mediterranean descent please do a check for glucose-6-phosphate dehydrogenase deficiency. (I would check it anyway.) It does cause a lifelong illness called thalassemia. In your case, as you didn't have any major symptoms until now - if you test positive for G6-PhD most likely is only a minor deficiency. However, people with G6-PhD have a higher intolerance to poppers to the point of being highly toxic. It also means that you are more susceptible to infections.  

2. Assuming that you do not have the above mentioned deficiency, the next one is Cytomegalus IgM - acute infection. This will most likely explain the drop of CD4 count. 

3. Ibuprofen. Known to cause skin reaction if used for longer periods of time. The more common symptoms are red circular spots on the inside of your palm. They are itchy and sometimes form blisters. Stopping Ibuprofen for a while will most likely resolve it, but do tell your doctor about your intake. Strength of ibuprofen is also a factor. 

4. Brand of poppers. Whilst it is true what @ErosWired said about poppers in the US, there are some slight variations in Europe, where amyl and pentyl variety are widely available. Heavy use, will be a co-factor in lowering your immune system barriers. So, try to limit your use of poppers for a while.

5. Lots of travelling.... Stress due to travel would be another co-factor in your immune system being attacked. Not getting enough rest and sleep, a constant change of diet, will do a number on a healthy person and it is certainly likely to have an effect in your case.  Frequent stays in hotels, airbnbs, flights, trains, are all source of infections, ranging from minor, non-consequential to more serious allergic reactions. 

6. If you are in Berlin, go to Checkpoint BLN. The clinic is geared towards gay men, and they will run a whole lot of other tests that 'regular' doctors in many places will not think to run. ([think before following links] https://checkpoint-bln.de/) It may cost you a bit, but I'd think it would be much simpler to run the tests more regularly.

7. Finally, Covid... The 'darling' of today's news! ... sigh... Yes, you may have had a covid infection, which again, explains the drop of CD4. 

As for the higher than usual levels of HIV, I wouldn't worry in the least, but.... Do ask your partner, gently as it may be, to do an HIV test as well. If he is already positive, run a HVL test on him too. Assuming that he is the top and cums inside you every time, it would be worth checking his stats. Since you only bottom for him, chances for you passing the virus on to him are very, very, very low.

Other than that, take a deep breath (without the poppers LOL) and relax. You worrying about a blip can do a number on your health. 

 

[ErosWired]

7 hours ago, EuRawBull said:

Brand of poppers. Whilst it is true what @ErosWired said about poppers in the US, there are some slight variations in Europe,

It should be noted that butyl and isobutyl nitrite are banned in the EU, so what you are likely to find are the amyl, pentyl, and isopropyl types (avoid the latter completely for eye damage concerns). The medical literature suggesting immune suppression is considerable.