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CD4 Percantage low but stable while absolute count drops?
Feb 8, 2009

For the past few years my CD4 counts were in the 400's and VL 15-20K. No meds were taken. Last two labs CD4 numbers plunged down (324 and 285) while VL climbed up to 25K and 30K respectively. HOWEVER, CD4 Percentage had remained stable and even gone up a point or two. In fact, at the highest CD4 count I had 6months ago (485), percantage was at its LOWEST peak (20), and now at its lowest CD4 count (285) percentage remains stable (22). Does it make sense to loose 200 counts in 6 months time, especially when percentage remains steadily, and how strongly would you recommend starting treatment due to past 6 month changes in count but not in percentage? Thank you very much!

Response from Dr. McGowan

The CD4 percentage can be useful when the numbers seem to be bouncing around alot. It tends to be more stable than the absolute CD4 count. The absolute CD4 count can vary alot..even within the same day. The number is calculated by multiplying the CD4% by the total T cell count (derived from the CD3 expressing cells). The absolute CD4 count is not measured directly. The CD4% is calculated by the labortaory doing the test,so CD4 counts measured in different labs may also give different counts. It is best to always measure the counts in the same lab (Was that the case with your numbers?). And, lastly, the CD4 counts that we measure are those cells in the bloodstream. Most CD4 cells are out in the tissues and move in and out of the tissues, especially at times of inflammation in the body. If you had a CD4 measure after an illness or a vaccination the count may dip a bit as the cells move into the tissues to fight the infection (but the % would be stable). The viral load may vary up to 3 fold just due to lab measurement issues. All your numbers are within 3 fold of each other.

The decision to start meds in your case has to be individualized. Some of your numbers have been below 350, and even your "stable" count has been below 500. The idea is to time the start of medication to prevent illness while not adding undue burden and toxicity. There is nothing wrong with starting therapy now for you as long as you are ready and commited to taking the meds and working with your health care provider to monitor for tolerability. It might relieve some of your anxiety about the bouncing numbers.

Good luck, Joe

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