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Confused about fluctuations and uncorrelated test results
Feb 27, 2008

I was diagnosed in Dec 2007 with a CD4 count of 490 (16%) and VL of 7000. In the past two months, I've had 3 blood tests in which the viral load has fluctuated -- down to 285, then 290, then back up most recently to 415. My percentage and viral load have remained constant. I've been told that the percentage 'corresponds' to an absolute CD4 count of 200, but how would my lab results really bear this out? Am I doing OK at the moment given my marginal CD4 labs but low VL? If the percentages are so reliable, why are they not used instead of absolute CD4? Does the percentage give any information at all given my lack of data over time, and is it at all more likely I been infected long given my low VL set point? Am I a slow progressor? How freakish am I, really?

For the record, I'm under the care of a resident at a teaching hospital who's doing a fantastic job so far. I'm comfortable with thinking in terms of likelihoods and I know the uncertainties seem to make doctors cautious, so my only frustration has been the answers I've been given seem 'by the book' instead of being drawn as well from my doctor's experience of care. Thanks in advance for any sense of what this means.

Response from Dr. Young

Thanks for your post.

If you have three independent tests that show a CD4% of~16, I'd be considering treatment.

CD4 percentages tend to have less day-to-day variability than absolute counts. You can see this in your own tests. Yes, your correct that in an "average" patient a percentage of 16 if roughly expected to yield an absolute count of 200. Some persons have a higher total number of circulating white blood cells, driving the total (or absolute) CD4 count higher than expected for any given percentage. It would seem that you are one of these persons. (This is not a freakish situation, but only somewhat uncommon.)

One's viral load also varies, but having a low viral load by no means means that you have (or have not) been infected for a long time.

I hope this is helpful, BY



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