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The difference between CD4 count and %

Aug 7, 2011

Hi, I tested positive about a year and a half ago, my viral load is still fairly low (3500) and my CD4 count is 590. According to most of the info I've looked up, most would say I'm still fine for not starting meds, but my doctor told me that since my CD4% is 22, I should really start thinking about starting on meds. I don't really know what the % means, though she tried to explain. Should I start meds? Thank you so much for your help.

Response from Dr. Holodniy

In general, you should be following the CD4 count and percent over time. The CD4 count is more variable and the CD4% more stable over time. A normal CD4 count in someone without HIV infection is between 500-1500 and the CD4% is 30-50%. That means in someone with a CD4 count of around 500 we would expect to see a CD4% of 30%. Given that your CD4 count is 590 with a CD4% of 22%, your doctor is concerned because your CD4% should be in the 30s and it appears that you have lost a significant proportion of your CD4 percentage. Thus, despite having a normal CD4 count and low viral load, it appears that things are starting to happen with respect to ongoing HIV replication, despite not having any symptoms or problems as a result of HIV infection. Many experts would suggest starting HIV meds to preserve immune function and control viral replication. Others might say wait and see what the trend is over the next few months.

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