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Strep and 250 CD4 drop?
Jan 7, 2008

I was diagnosed this past September and am not currently on any meds. My first labs showed a CD4 of 804 (24.8%), and a VL of about 43k.

My most recent (and only my second) lab has shown a drop in CD4 to 569 (26%) and a VL drop to about 19k.

Between the two labs I had a number of things happen. First, I had a biopsy to rule out lymphoma since I've had enlarged lymph nodes since what I'd think was my seroconversion (everything came back benign). A little over a week after the surgery the surgical sight became infected with strep in a hematoma. I was in the hospital for 3 days on IV antibiotics and then was on augmentin for a week after being discharged.

Finally, the week the blood for my last labs was drawn I came down with a regular case of strep (not an infections of my surgical sight) on Monday and had the blood drawn on Friday, after finishing my Zpack that morning.

The drop in my CD4 concerns me, but given all of the circumstances between my first and last labs I'm not sure how much stock to put in this lab result as some kind of trend. I did notice the % stayed relatively stable, and I'm also not sure if a such a drop in my VL would be indicative of a "real" CD4 drop like that.

I was just wondering your opinion on the situation. Right now I'm just going to have to wait for my next labs to see what happens, but I just wanted an opinion on what might be going on.

Thanks for your time and wonderful website!

Response from Dr. Holodniy

The important number to also watch is the CD4%. It is a much more stable number over time. In your case it did not change signficantly. The absolute CD4 count is much more susceptible to all sorts of things: other ongoing infections, stress, time of day, among others. Your viral load only had a two-fold change, which is within assay variability. So no real significant change. Bottom line, I would not be concerned with the interval differences between the two tests.



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