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High cd4 counts Asplenic - Worried
Jun 3, 2005

Hi Doc - hope you can assist with my worry. I am a 50 yr old man and was diagnosed H I V + 16 months ago. At the time my numbers looked good - a cd4 of 1700 - V/L 6,800. and a cd4 % of 26. However I have not felt well for this period .Weakness fatigue - some hearing loss with tinnitus A small white ulcer on the tongue margin lasting to date 7 weeks. plus transient dizziness on turning the head. I was treated with doxycylin for a possible undertreated syphilis infection two moths ago and felt very much better but the hearing oddities persist. Two weeks ago I noticed a remark about asplenic patients showing strangely high cd4 counts whilst trawling the net and this has led me to think that my own numbers may be unreliable. ( my spleen was ruptured and removed some 40 years ago after a road accident).The last figures I have - taken in February this year show the cd4 at 1,150 - V/L at 68,000 and cd4 % at 24 I am told that I may be a long term non progressor - but the steep fall of 600 T cells in little over a year plus the symptoms I have lead me to suspect my immune system may not be as strong as previously thought and that I may be getting close to the danger zone. Worryingly my doctors seem to be unaware of the cd4 differences in asplenics and have given an appointment for three months time. I am concerned that within this time I may lose the advantage of an early diagnosis and strong immune system. Do you think I have cause for concern ? Should I consider asking to be put on HAART P.S. I have asked several medical consultants and two experts on HIV and they are unaware of any problem in reading cd4 counts in asplenic patients. Who is right? - Is there controversy on the subject? Hope you can shine light here - thanks.

Response from Dr. Wohl

Patients without a spleen have higher CD4 cell counts. This is well documented and is likely due to the concentration of CD4 cells in the normal spleen. No spleen and these cells continue to circulate in the blood.

So, your absolute CD4 number of 1000+ is a bit misleading. Your CD4 percent, however, remains fairly accurate even without a spleen. A CD4% of 30+ is generally normal. Therefore, your CD4% is a bit low. However, this is not a basement level CD4 and above the threshold one would expect for opportunistic infection development (generally less than 15%).

If you are having obvious symptoms related to HIV, given your CD4% and the drop by 2% over a short time, HIV therapy may indeed be advisable. Your clinician's ignorance of the effect of splenectomy on CD4 counts is concerning. If possible, I would seek out a very experienced HIV treater.

DW



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