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Now Concerned about CD4 Percentage
Aug 17, 2009

Hello there. I submitted the question, below, a couple of days ago. Since then, I have been searching your site on cd4 percentage. My doctor has always said he doesn't get concerned about cd4 percentage, as he looks at actual cd4 count. However, when I read other opinions, especially on this site, it seems cd4 percentage is very much relevant. I am very concerned that after 3 years on meds, my cd4 percentage is still very low. I have gone from an initial diagnosis of cd4 count of 105 three years ago to 324 in april '09 of this year, but then back down to 267 this week. CD4 percentage was 12.4% in April 09 and 15.6% this month (July '09). I have been VL undetectable since starting treatment three years ago. I am quite confused as to if I am actually have good results, or so-so results, and am very confused about the percentage situation. My doctor is not very helpful about this. My email of a few days ago is below. Thanks for your help.

_____________________________________________

Original email:

Hello there. I was diagnosed three years ago this month. At that time, I had CD4 count of 105, and viral load of 5200. My doctor started me on Sustiva/Truvada, as well as Sulfamethoxazole, and at my next check three months later, my VL was undetectable and CD4 had risen to 130. Over the past three years, I have remained undetectable, and have seen a steady rise in my cd4 count. At my check last April '09, I had a cd4 count of 324, cd4 percentage of 12.8%, WBC of 5.2 K/ul, RBC of 4.31 M/ul, and a Lymph% of 45.4%. VL was still undetectable. At that time, my doctor discontinued the Sulfamethoxazole, and switched me to Atripla. I received my test results today for my July check-up, and although I am still undetectable, for the first time since all this started my tcell count has gone DOWN a bit, from 324 in April to 267 in July. Although CD4 percentage had increased from 12.8% in April to 15.6% in July. WBC is down from 5.2 K/ul in April to 4.9 Ku/l in July. RBC down from 4.31 M/ul in April to 4.14 M/ul in July. And the biggest change seems to be in Lymph%, which was 45.4% in April, and is now 33.1% in July. My doctor said it was just "fluctuation" but I am worried because this is the first time my CD4 count has gone in the wrong direction since I started. Could this be because of the change from Sustiva/Truvada to Atripla? And/or could it be because I was on a pretty potent antibiotic Sulfamethoxazole for three solid years, and have just stopped? Could it indicate that my meds are starting to not be affective? Or is it truly that one's tcell count is a snapshot at any given time, and that was my snapshot on that day? I was also wondering if back in April, since my WBC, RBC, and Lymph's were also elevated, if maybe I was fighting a little cold on the day or something. I guess I am just freaked out because I have made such steady gains since I started treatment, and now I fear I am backsliding. One good thing -- my cholesterol had climbed to 280 when I had everything checked in April, but solely through diet, I lowered it to 207 in July, Lowered my LDL from 177 to 107, and my Triglycerides from 176 to 103. I REALLY did not want to go on Lipitor, so at least there is this good news. Thank God for oatmeal. Anyway, thank you for helping me with me dip in CD4 count, as I am very worried.

Response from Dr. McGowan

Thanks for your post. This can be a very confusing topic. In your case it is all fine since both numbers are increasing appropriately. With an undetactable viral load your body has been healing over the past 3 years. Both your CD4 count and % have been increasing, which is the best result. The absolute (or total) CD4 count is the one we use to assess the strength of your immune system and used for guidelines of when to start antiretroviral treatment or to start and stop preventive treatment, such as trimethoprim/sulfamethoxazole. The CD4% reflects the balance between the 2 major types of T cells: the CD4 helper cells and the CD8 suppressor cells. As the balance becomes restored the % of CD4 will increase. The CD4% may show a bit less fluctuation than the total CD4 count and can be helpful to look at if the total CD4 count is moving up and down alot, if the % is stable or increasing, especially when the viral load is undtectable that can be reassuring. Best,

Joe



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