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Normal PCR with low CD4
Mar 15, 1999

I have a patient whose spouse is HIV positive ( ELISA and confirmed on Western Blot).They have had unprotected sex since July 1998. His ELISA HIV 1&2 is negative and his PCR is negative but his CD4 count is 490. This suggests immune suppression in the absence of HIV infection. Can you suggest further testing to clarify the problem.

Response from Dr. Holodniy

Although his CD4 count is a shade low, I would also look at the percentage of CD4 cells, ratio of CD4/CD8 cells (should be 1 or greater in uninfected people), and the total white count (which could make the CD4 count low). Also make sure he had no other concomitant infections or meds at the time the T cells were drawn, which can also drag the number down. Given the negative serology and PCR, it makes HIV infection unlikely. The CD4 count is too high for CD4 depletion syndrome (usually MH



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