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Elisa +. WB -. CD4 counts not Normal
Dec 18, 2004

Doc Bob. Your the best and I need your help.

I just did a HIV test at 1 year from the exposure and it was positive, but WB was negative to confirm it.

Anyways, when my CD4 count came back, they were 2500 and CD 8 was 1203. And the ration was 2:1 cd4:cd8

Why did my CD4 count came back so high ? Does that mean I have HIV ?

I am confused. My doctor says hes not sure why that happen.

Please put me straight.

Ben

Response from Dr. Frascino

Hi Ben,

I don't know why it's the gay guy who always has to set people straight, but OK, here we go . . . .

Your negative Western Blot (WB) test did not confirm your positive antibody test. In fact, since the WB was negative, it essentially invalidated the screening antibody test.

Next, why was a CD4 cell count even ordered? Your WB is negative, so a CD4 cell count is irrelevant. But if you insist on knowing about the ins and outs of CD4 cell counts, here's the abbreviated scoop. The normal range of CD4 cell counts varies a bit form lab to lab and with various testing technologies, but in general is in the range of 500-1500. The CD4 cell count is the product of three variables:

1. white blood cell count,

2. the percentage of lymphocytes and

3. The percentage of lymphocytes carrying the CD4 receptor.

All of these variables can vary. (That's why we call them variables!) Other factors that influence CD4 cell counts include corticosteroids, diurnal variation and even season variation! Regarding your 2:1 CD4:CD8 ratio, that's completely normal! Something else you might want to check is the "CD4 percentage." It's often a more reliable (and stable) way to evaluate CD4 cells compared to the absolute CD4 number, because the "percentage" number eliminates several of the other variables noted above.

So, before this gets even more complicated, what do you need to do? First off, I'd repeat your HIV antibody test. If negative, you are definitively HIV negative and your initial positive test was a "false positive." If you repeat HIV antibody test is positive, a Western Blot should be done. If it's positive, you are most likely HIV positive. (This is highly unlikely.) If it's negative (same mixed result as your first antibody and WB tests), you'll need an HIV PCR to sort out these indeterminate results. By far, the most likely scenario for you is that your initial HIV antibody test was a "false positive" and you are indeed HIV negative. OK?

Now you can set your doctor "straight", if he's still confused as well?

Good luck.

Dr. Bob



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