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Does VL/CD4 count really tell how long infected?
Feb 8, 2009

Good day Dr. H. I'm a little confused. How is it that I read somewhere that one person had a CD4 count of 210 and a VL of 6,000 and states their doctor says they may have been infected for 7-10 years and my uncle was just diagnosed with a CD4 count of about 20 and VL of 700,000 and his doctor says he has likely been infected for 5-10 years? What is the likely answer with those discrepancies in lab numbers? Trying to get all the info I can to assist in my uncle's care and keeping up of his spirits! Appreciate your timea nd response.

Response from Dr. Holodniy

It is difficult to pinpoint exactly when most people became infected. First a few math principles. The normal CD4 count range is about 500-1500. We don't usually know what a person's CD4 count is before HIV infection because we rarely measure in people without HIV infection. So you don't know if someone is starting at 500 or 1000 when they become infected. Next, from older natural history studies, the average CD4 count per year is around 50-70 cells per year, in the absence of HIV treatment. So, if someone has a CD4 count of 20 now, and in the absence of prior known HIV tests that were negative to better pinpoint a time frame of infection, a 5-10 year range is not unreasonable.



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