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ICL
Jul 1, 2007

I have a question about the definition of Idiopathic CD4 Lymphocytopenia (ICL). First off I know about the qualification of less than 300 cd4 count ( or less than 20%) on two or more occasions and being HIV negative.

One thing I want to know is does the person also have to have an AIDS defining disease or can they be clinicly asymptomatic?

Also is the less than 300 T cell count (or under 20%) mandatory? In other words if a person had an AIDS defining disease(lets say chronic TB), was HIV negative, but had a T-cell count of 650 would he qualify as ICL or would he be just a TB patient?

Thanks for your help, Daniel

Response from Dr. Frascino

Hi Daniel,

The case-definition criteria for ICL include:

1. CD4 count less than 300 or CD4% less than 20% on two or more measurements.

2. Lack of evidence of HIV infection.

3. Absence of alternative explanations for the CD4-cell lymphocytopenia, including Sjgren's syndrome, sarcoidosis, radiation, atopic dermatitis, collagen vascular disease, steroid therapy or lymphoma.

Please note, transient unexplained decreases in CD4 cells may occur in healthy persons.

To answer your specific questions:

1. No, a person does not need an AIDS-defining disease to have ICL. They need only to meet the three criteria listed above.

2. Is a count of less than 300 or less than 20% mandatory? Yes, it's the first criterion listed above.

3. A person with TB and CD4 count of 650 would have TB, not ICL, because she didn't meet this first criterion above. (I should also point out that TB is only considered to be an AIDS-defining illness in folks who definitively have HIV infection.)

Dr. Bob



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