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Jul 28, 2011

Hi, my dear doctor

In november of the 2010 my cd4 = 585 and 47%, bad in july of the 2010 my cd4=625, bad 37%. this is important o not. please expleime this change. Thank you very much

Response from Dr. McGowan

Thanks for the question.

The CD4 count and the CD4% both give us information on the strength of the immune system. For both: the higher the better.

Usually all we really need to look at is the CD4 count, but sometimes, like in your case, we need both.

If we just look at the CD4 it looks like a drop from 625 to 585. Which is a slight move in the wrong direction. But the CD4% went up alot from 37% to 47%!

So, how do we explain it. One thing to remember is that we only measure the CD4 levels in the blood, but in fact most CD4 cells are not in the blood but in the tissues (the liver, lungs, intestines, etc). So as the cells move in and out of the blood everyday to fight infections the total numebr we measure will vary. It is like looking at the tip of the iceberg as it bobs in and out of the water, it is generally the same height but changes a bit up and down.

The CD4% tells us about the balance of the immune system. There are 2 major type of T cells: CD4s and CD8s. HIV infects CD4 cells. As HIV damages CD4 cells it causes a loss of CD4 cells and an imbalance between CD4 and CD8 T cells. The CD4% tells us about this balance. In July you had 37% of your T cells as CD4 but in NOvember it had gone up to 47%!. This is a much better balance in your immune system.

So, although the total number of CD4 went down (reflecting movement of cells from the blood to the organs- like the iceberg bouncing down into the water), the CD4% went much higher (which represents a stronger content of the ice in the iceberg) indicating a better balance of your immune system. Overall the Novemebr numbers are preferrable.

Hope that helps clarify things.


treatment simplification
Reason to change meds

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