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What undetected CD4 count is mean?
Nov 7, 2010

The patient is a 58 yrs old male patient who was diagnosed to have HIV three years back during which the WHO clinical stage was two and CD4 count was not detectable with the WBC count of 4700 and Lymphocye of 47%. We have three repeated such counts but CD4 count was not detectable in all the three where as the WBC and differential is almost the same. The sample was being managed after transported to nearly 50 KMs. Recently have got our own machine and tried it again but it all turned out to be the same. The patient is clinically doing alright and we started him on cotrimoxazole prophylaxis therapy. What are the possible reasons for the undetactable CD4 count while a patient is clinically fine especially in an infectious set up? What shall we do for this particular client of ours? our set up is a remote HC in E/Africa where you don't have access to the sofisticated tests that you might suggest. The maximum possible test that we can do is CD4 counting> Thank you in advance

Response from Dr. McGowan

Thanks for your post.

Seems as though this would be a laboratory error as the WBC and total lymphocyte counts are normal. There may be a problem with the FACS analysis or processing of the sample for the CD4 testing. Although absolute lymphocyte counts cannot substitute for CD4 determinations. Can you get the full report? If the CD3 count, CD4% and CD8 count and CD8% are also consistent with such a low CD4 then it may be accurate but that would be important to know. Continue prophylaxis till you see the full report.

Best, Joe



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