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CD$ Number Vs. Percent
Aug 10, 2007

Hey Dr. Bob, What is the latest consynsis on CD4 Counts and CD4 Percent? First set of Labs = 220 / 12% / 44K V.L. Now, after Atripla SIX WEEKS- 285 Count / UNDER 300 VIRAL (yippy & Wow) and CD 14% - My arrogant doc states- " Once considered Aids with under 14% - Always AIDS" - I am not buying it...What is the latest word? I understand the threshold as Under 200 CD4 I feel He should not classify me as having AIDS...especially with my quick CD4 increase after 6 weeks and ZERO Phy Signs. Any words of wisdom would be appriciated. Thanks for all you do!!!

Response from Dr. Frascino

Hi,

Arrogant or not, I have to agree with your doc on this one. The Centers for Disease Control (CDC) AIDS surveillance case definition for adolescents and adults categorically states that HIV disease becomes "AIDS" when the immune system becomes seriously damaged. They define seriously damaged as a CD4 count of less than 200 cells or CD4 percentage less than 14%. The diagnosis of AIDS is also established if an HIV-positive person at any CD4 cell count gets certain opportunistic infections or malignancies, such as PCP (Pneumocystis carinii pneumonia), KS (Kaposi's sarcoma), CMV (cytomegalovirus), etc. Once the AIDS diagnosis is established, it does not change, even if the CD4 cell count and/or percentage improve above the AIDS-defining limit. Similarly, even if the opportunistic infection resolves, the AIDS diagnosis remains. However, remember, "AIDS" is merely an artificial designation that the CDC created in order to count cases (for surveillance purposes). It doesn't really hold prognostic significance. In other words, there are some very healthy AIDS patients walking around today, just as there are some very sick HIV-positive but not AIDS-defined patients struggling to survive.

That you have AIDS and that is indeed a fact you're going to have to accept shouldn't diminish your "yippy & wow" reaction to your response to Atripla! You are responding well to treatment, both immunologically (increasing CD4 count) and virologically (declining HIV plasma viral load) and this is excellent news! OK?

You can read more about HIV/AIDS diagnostic criteria and surveillance definitions in the archives, as this question comes up not infrequently.

Finally, if your HIV specialist is indeed arrogant, you should consider finding one with whom you can develop a more collegial and cooperative relationship.

Be well.

Dr. Bob



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