Hi Ron, that's a good question and I will try to answer this as best as I can from a discussion that I had with my ID doctor.

Once you hit Undetectable and remain so the CD4 count is no longer needed. The old science behind HIV care was to know both as the CD4 counts were a good indication of one's immune system; this is no longer the case for someone in the U=U category.

Lets use me for example. My last known CD4 count was 300. That's not a pretty number if we go by the old system of doing things; but I am not in danger of any opportunistic infections (OIs) since my VL is under 25 copies. Now if the VL was DETECTABLE and my CD4 was at 300 I would be more in danger of any possible OI's. Since I have been U=U for 8+ years Infectious Disease (ID) no longer orders a CD4 test as it simply just doesn't matter. Is it good to know on hand? Sure.... but is it necessary? NO. If ID ever did order a CD4 now, its because I requested it.

There could be (Phone number can only be seen by the question and answer creators) reasons why you went from 1200 to 786, but by the old science you're still in the golden range of a healthy immune system. Could have been just an off day? But back to what my main point is; since you are U=U the necessity of the CD4 is invalid. Nobody should ever ask you what your CD4 is, just that you are in the U=U/Undetectable status.

Essentially, in 2025 all you ever truly need to "worry" about is your VL - nothing else. I know its a tall ask seeing we were basically programmed to play the numbers games and include the CD4, but that is just simply no longer the case, making U=U even more an important status for us and giving us more normalcy when it comes to managing our care as we no longer have to have unnecessary stressors worrying about those CD4 cells.

In a Long-Term U=U person a CD4 of any number is no longer an indication of a "healthy" or "strong" immune system - as you have people like me who are chronically under 500 but no longer considered "in danger" as I would be if the virus was replicating and I had no control of it.

Does this make any sense? I truly hope it helped.

Mike

Yes, you can be very happy with your numbers.
I was told by a medical professional that your T Cells will vary at all times. It’s the consistency that matters.
I started meds with 25 T Cells, yes just 25.
I spent years below 300. I never knew why until I decided to try oral THC. I’m not a user by any means. At the same time, doctors would always ask if I was stressed. I would reply no.
But after the first six months of using THC, my T Cells shot up over 300 for the first time in almost ten years. Later, it progressed to over 500 then 600.
It wasn’t the THC, it was my stress levels that I did not know influenced my sleep patterns. 5-10mg 30 minutes before bed and I would wake up with 7-8 hours of sleep. I would go on and off of the oral for the next three years after that. I have not used it in over 6 years. My sleep patterns are better and I have lowered my stress levels and sustained a T Cells count over 500 ever since.
I also take magnesium supplements that help with sleep but you have to check your medication adversity to supplements before you do, it’s online or ask your doctor/pharmacist.
Oh, and THC is not for everyone. Again, ask your primary about this.
Hugs and be well!
❤️🤗

My CD4 is 2325 and still undetectable.

For me, it would be tcells over viral load.

GM They are both very important to me