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CD4 vs Viral load
Sep 22, 2009

Dear Doctor,

I have been diagnosed with HIV since 2004, and since then my viral load went from just over 300 copies down to 48 copies or undectectable while my CD4 count went from just over 300 up to just over 500. Recently, my CD4 count began dropping from just over 500 to 325 on my last test in July. The count decline is shown in three different test result between March of 2009 to the last test in July 2009. The other amazing factor is that with this decline in my CD4 count my viral load is declining as well going from a 54 copies now down to 48 copies. This is rather puzzling as my circumstance seem to defy medical logic. Please help.

Response from Dr. McGowan

Thanks for your question.

What you are likely experiencing is normal variability that can occur with blood tests. The tests are not "exact" measures but depend on many factors such as the temperature, dilution of the specimen, how it has been processed, etc. So even if the same sample is run twice you will not get the exact same number both times.

For example, there is no real difference between having a viral load of 54 and 48. 48 is more reassuring because that is the cutoff value for "undetectable" but the 54 was probably the same.

To interpret the CD4 may require a look at the CD4 percentage (%) which is a measure of the balance between the types of T cells. As you get better from HIV infection, the CD4 count and the % will both go up. The CD4 count is more variable than the % and can move up and down more dramatically. So if the CD4 % is not dropping than that should reassure you that things are stable. Ask your doctor to look at that number for you.

Best,

Joe



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