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results what they mean

Aug 6, 2005

Hi Dr.

I was recentlt diagnosed HIV + about twoweeks ago - I had the results of my first bloods today My viral load was 200,000 and my CD4 count was 430. The doctor was worried about the percentage CD3 -CD4% which was 16. First, I dont really understand what this means?

Could you be kind enough to explain what these results mean ? The doctor did explain but my I didnt really comprehend.

Many thanks. Nick

Response from Dr. Frascino

Hi Nick,

I am sorry to learn of your recent HIV diagnosis. It's not uncommon to be a bit (actually much more than a bit) confused about the laboratory tests used to monitor HIV disease. I recommend you review the information on this site, particularly the "Just Diagnosed" link that can be accessed under the heading Quick Links on The Body's home page.

Briefly, the CD4 cell count is an excellent method of gauging HIV disease progression. Together with HIV viral load determinations, it provides information as to when HAART therapy is indicated and how well a specific anti-HIV drug combination is working.

CD4 cells are a subset of T cells, which are a subset of lymphocytes. Lymphocytes help the body battle infected or cancerous cells by coordinating the body's immune response. A normal CD4 cell count in a healthy adult is approximately 600-1200 cells/mm3. CD4 cell counts can fluctuate due to a variety of factors, ranging from fatigue and stress to infections and vaccinations. HIV targets and infects CD4 cells. As HIV disease progresses, CD4 cells are destroyed, leaving HIV-positive folks increasingly vulnerable to infections and some cancers. When the CD4 count falls below 200 cells, individuals are susceptible to infections, such as PCP (Pneumocystis carinii pneumonia). As the count declines further to the 100-cell range, opportunistic infections, such as cryptosporidiosis and toxoplasmosis, become more likely. Further decline into the 50-cell range increase the risk for MAC (Mycobacterium avium complex) and CMV (cytomegalovirus).

Because CD4-cell counts are so variable they even vary with menstrual cycles in women and time of day HIV specialist physicians also monitor CD4 percentage (CD4%). This is the proportion of total lymphocytes made up of CD4 cells. This value gives similar information about immune-system integrity (and opportunistic-infection risk), similar to the absolute CD4-cell-count number. The percentage is usually more stable over time than absolute CD4 cell counts. A normal CD4 percentage in a healthy adult is 30-60%.

An absolute CD4-cell count below 200 cells/ mm3 or a CD4 percentage below 14% confers a diagnosis of full-blown AIDS (as opposed to just "HIV positive").

HIV viral load tests measure the amount of genetic material (HIV) in the blood. This test is a measure of how actively HIV is replicating (multiplying). Viral loads above 100,000 copies/ml are considered high, while levels below 10,000 copies/ml are considered low. Levels of HIV too low to be measured are termed "undetectable." However, an undetectable viral load does not mean HIV has been eradicated.

To sum up, CD4 counts (absolute or percentage) reflect the integrity of the immune system or how much damage HIV has done to the immune system. HIV viral load indicates how actively HIV is multiplying.

Your HIV specialist may well be concerned that your CD4% is approaching the 14% cutoff that would signal a full-blown AIDS diagnosis and your increased susceptibility to PCP. Your high viral load could be indicative of recently being infected (viral loads are frequently quite high during the initial stages of HIV infection) or a more chronic infection with significant viral replication. A repeat CD4 count and percentage and HIV viral load in two to three months are warranted to differentiate between the two possibilities and to ascertain whether potent antiretroviral medications should be started.

Good luck, Nick! I'm here if you need me.

Dr. Bob

Oprah to the rescue
frere decede du sida et panique suite aux affirmations du dr.Day

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