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Wild ride of T cells: are the recent results possible or clearly lab error?
Dec 20, 2003

Dr. Boyle, I would be very grateful for your advice and counsel on a strange saga of my T cells:

I was infected and diagnosed with HIV a couple of years ago (ELISA and Western Blot). The virus was never typed, but was thought to probably be a non B strain, due to having contracted it heterosexually in South America.

A few weeks after severe primary infection symptoms, my CD4 count was approx. 900, CD4 percent 42 and CD4/CD8 ratio .9.

Throughout 2002, the CD4's dropped to their lowest point of 580, ratio always at .9 or 1. In December 2002, the CD4's had climbed back to 1,100, percent was 46 and ratio again 1.

From the start of 2003, my CD4's started a descent again. In the spring they were down to 600, the CD4 percent was down to 35 and ratio again at 1. Through the year, the CD4's finally climbed back to 750, percent down to 32 and ratio at 1. This was in September, 2003.

Then, please fast forward to last week. My CD4's came back as 1,500, CD4 percent over 50 and CD4/CD8 ratio at 1.5! Total Lymphocytes were over 3,000! I would be delighted, but for the following: 3 weeks ago, my white blood cell count was 6, my total Lymphocyte percentage was 34 - so, since the CD4 numbers/T cell subset is a function of WBC, Lymphocyte number and CD4 percent, my CD4 count would have been just over 1,000 (if I use the 50 number that was in my T cell subset last week).

My question is this: have you ever seen patients with T cells that fluctuate like this and where suddenly, the CD4's and ratio soar to large numbers? How can this happen in the context of HIV..I thought that there was always a gradual decline in CD4 numbers and also that the CD4 was a stable number - yet, mine went from a CD4 percent in the low 30's to over 50 in a few months. Also, computing what the T cell number would have been a week before this last one, it would only have been just overa 1,000. So, are these fantastic numbers clearly Lab error or are they viable? Also, could the wild ride of my T cells tell anything about the state of my immune system and its battle with the virus within?

I also have severe viral symptoms still - diarrhea every day, peripheral neuropathy, skin flushing, chronic pharyngitis and painful nodes in the groin and throat. How is this possible with these Lab results? My viral load throughout has been a mystery - usually undetectable, sometimes blipping into the low hundreds. Strangely, though my lymph nodes have often been painful, they have almost never been swollen...not even during ARS.

Anyway, this is a long story, but I would much appreciate your thoughts on the T cell subset as well as on the huge fluctuations in T cells. Should I repeat the T cell subset or rely on the probability that there was no Lab error? (blood draws for all T cell subsets was at approx same time of day).

Many thanks.

Response from Dr. Boyle

Regardless of the absolute number at any particular time point, the T cells overall look pretty good, and always have, and I would try to avoid fixating on particular numbers, although I know that is easy to say and not so easy to do. I don't see a need to repeat the labs at this time.



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