CD4 and RNA numbers fluctuation

[Malesack]

My neighbor found out he was poz in January.  The doc started him on ART.

In Feb he was 227 on the CD4 and over 500 on the PCR RNA.

in June he was retested and learned he actually went down to 200 on CD4 while the RNA dropped to double digits.

Since below 200 is AIDS, is it normal to have fluctuations in the CD4 numbers each 3 months of testing?  RNA, CMP and CBC all show vastly improved numbers in normal ranges but the CD4 result caught his attention.   

 

 

 

[descartes70817]

All I know I was tested for was my CD4 cell count and my viral load but my CD4 cell count dropped to 34 before I began taking meds, while my viral load was around 100,000. Since 2017 (when I was full blown) my CD4 cell count is still in the "compromised immunity" range but my viral load is undetectable. That said my CD4 cell count did vary from test to test and my viral load did spike a couple of times - when I took an unscheduled break from my meds.

One thing I was told was that at my age my CD4 might never reach normal levels and is it typically in the low 400 range

[Malesack]

Thanks for sharing that.  I’ll let him know.

[funpozbottom]

HIV throws the immune system off balance. As the virus comes under control and the immune system begins to recover, you can see fluctuation in lab numbers.  In my own treatment, my early labs were kind of two steps forward, one step back. I'd have two reports with gains followed by a report with a decrease in CD4. Treatment is a long term process, and everyone responds differently to medication. There are lots of reasons why a lab may show a decrease on one report. It's the overall trend that is important. 

[kspozcum]

As always, take anything I say with a grain of salt, and please refer to a medical professional that specializes in infectious disease.

However, as stated before, CD4 counts can easily fluctuate on a number of different factors, including effectiveness on treatment.

First, a background on the treatment process. Typically, most infectious disease specialists will run a genotyping test to confirm genetic susceptibility to different medications, and based on this, a medication that matches will be picked. Typically, initial medications will have several different drugs in them in order to provide a larger array of coverage. As numbers start to stabilize, the provider may choose to go to a different drug or adjust dosage. None of it will happen overnight, but the number one thing they test for on checking a medication is effective is viral load. The ultimate goal is to reach an undetectable level on your viral load (typically less than 200 copies per mL of blood). However, new generations of testing can detect down to, if memory serves me correctly, 20 copies per mL.

As for CD4 counts, these can be a bit more tricky. A large number of factors can affect this number. Even just having seasonal allergy symptoms, or not drinking enough or too much water can throw these numbers off, as it can affect serum levels in the blood. As you said before, the other levels are within normal range, I assume showing his immune system is functioning within normal ranges. Knowing from experience with my partner, his numbers fluctuated in the low 200s for almost a year before finally going up above 300 a year out. It took almost 2 years before he hit the expected normal range of 500+. All other values were normal, with the occasional spike in total WBC (white blood cell) counts based on numerous factors (ie. dehydrated in the summer, seasonal allergies in the spring, etc). Even my own number can fluctuate greatly from test to test. I, for example, had CD4 counts in the 1100 range on initial testing yet have gone down to 400 once and as high as 1700 (was actively sick at the time).

One thing that is unknown here is what his pre-infection CD4 counts where. Idiopathic CD4 lymphocytopenia (ICL) is a condition in non-HIV infected individuals where the person has chronically low CD4 counts without any HIV infection. Also, has he been sick recently, as many infections can artificially lower the number as the body fights off infection. Even things such as herpes (which a lot of people have been infected with -see chickenpox-) can lower this number. Has he previously had cancer? Previous treatment with chemotherapy can also lead to chronically low CD4 counts. Even smoking, poor sleep and diet, and alcohol use can affect these numbers.

Most likely, his ID doctors will want to monitor this condition with regular blood work to see if it is in fact a blip on the bloodwork, versus something more.

Edited 7 hours ago by kspozcum
removed extra spacing

[PozBearWI]

Yes our VL and CD4 vary over time.  I'm approaching the two year point and there have been pretty wide swings although my number overall have been pretty tame compared to most fellow poz guys I know.