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Low/Dropping CD4 absolute vs normal CD4%

Apr 22, 2007

(Sorry this is so in depth but I want you to know all the info so you can understand my situation.) I've been Positive for almost 4 years and actually was diagnosed while seroconverting in 2003. After about 2 months my VL was down to <50 without meds. During the first 2 1/2 years I stayed <50 with a few blips in the low hundreds. During that time my total lymp count averaged 1600-2300, a CD4/CD8 ratio of about 1.1, an CD4 staying between 600-900 and percentage averaging 40%, CD8 averaged 750, without any trends. I thought the numbers had settled, but in 2006 something strange happened. My CD4 total started slowly dropping. I tested more often to watch it. It went like this: 656 35% , 559 43%, 541 39%, 420 42%, 570 38%, 531 43%, 352 38%, 590 48% and my last test 4/2007 was 554, 40%. And along with these low CD4's of course my total lymph count has dropped from 1600-2300 to as low as 900 when the CD4 was 352. My CD4/CD8 ratio is higher though at 1.4 now and the CD8 has also dropped to the 400 range during this time and all my VL tests have been <50 pcr and <75 when they checked Bdna as well. I have of course talked with my HIV doctor and he talked with researchers and he really is puzzled with no answers. My question is, What really is the state of my immune system with this drop in TOTAL CD4? With no VL and steady percentage you would think it was ok, but I am worried. How, and/or why do I have CD4 counts of 352 and 420 but 40+%? Feel free to CC this question to as many Dr's on your site or anyone else you think may be able to shed some light on my situation. I've done research and can't find any publications that mirror my situation. Besides for normal life colds my health has been fine through it all. Thank you.

Response from Dr. Holodniy

I don't find your results concerning or that uncommon. The CD4 percent is going to be a more stable number over time. The absolute CD4 and lymphocyte count can vary significantly depending on many environmental factors (time of day, stressors, medical illnesses or infections, immunizations, different labs, among others). The fact that your viral loads are undetectable and that your last CD4 count/percent is in the normal range indicates to me that nothing significant is going on.


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