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Higher CD4 numbers, percentage and CD4/CD8 ratio in late afternoon versus late morning?
Apr 11, 2004

Do you usually find CD4 and B cell (CD19) numbers to be higher when blood is drawn in the late afternoon (e.g 4:30PM) versus late morning (11:30AM)?

Specifically, is there a significant CD4 increase in the afternoon that would explain why an 11:30AM blood draw would yield 950 CD4's and 44 percent versus a prior 4:30PM blood draw three months ago that showed 1,050 CD4's and a 49 CD4 percentage? Does the afternoon increase also hold true for a higher CD4/CD8 ratio and for an increase in B cells (CD 19's) number and percentage?

I'd appreciate knowing your experience and whether there are any studies or anecdotal info's re average increases due to afternoon circadian rhythms.

Thanks so much.

Response from Dr. Holodniy

There can be a significant diurnal variation in lymphocyte subset quantitation during the course of a day. The numbers presented are not atypical of the kind of difference one might see. Counts are usually lower in the morning and higher in the afternoon. This is not specific to HIV infection. Those who are HIV infected with t cells in the normal range, have the same type of variability as noninfected people. When CD4 counts are < 200, the diurnal variation is blunted or nonexistent. Many things can cause variation or blunting in this diurnal variation, including other ongoing infections, vaccinations, stress, exercise, recreational drug use, exogenous steroid use, among others. There is less known about b cells, but I don't think there would be any reason not to think that they would be under the same diurnal periodicity.



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