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absolute CD4 vs % CD4
Dec 19, 2004

I have been HIV + for nearly 20 years and have not taken antiviral meds. My viral load has remained relatively low (< 10,000 bDNA) and absolute CD4 count always over 350 with wide swings from a low of 350 to about 600. My Doc commented on how he doesn't normally see such wide swings in abosulte CD4 numbers, but mine have always fluctuated that way. My % CD4 was reltively stable in the 23-25% range, however, over the last year it has trended down to a low of 16% 3 months ago. I am due for another lab draw this month. My Doc has suggested considering antiviral treatment if I drop to 15% CD4 or less. I tend to agree with him, but am perplexed as to why, with a low viral load and an inconsistent absolute CD4 count, I am seeing a consistent decline in % CD4. Should we be checking other abosulte lymphocyte numbers besides CD4?? Thanks!

Response from Dr. Holodniy

If the decline in CD4 percentage is consistent over several lab tests, then it is probably real. Given that trend, I would agree with your doctor, treatment is indicated. Given ongoing viral replication for over 20 years, I think you have just reached that point where your CD4 cells are beginning to lose the battle. Better to intervene now and preserve your immune system.



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