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Higher CD4 in the afternoon??
Dec 3, 2004

Hello... I've run across a couple of studies & papers that seem to suggest that a CD4 count can be as much as twice as high if taken later in the afternoon, after a full night's rest. Is this something you have encountered & does it have any significance?

Also, is the ratio or percentage of cd4 cells a more important marker of immune function than the cd4 total alone?

Response from Dr. Conway

CD4 counts are actually higher in the morning and lower in the evening and may also be artificially lowered by an acute illness of any kind. This is why, for routine monitoring purposes, we ask our patients to always have the test done at the same time of day (so we can compare all of the results that are in the chart) and to delay taking the routine test if they are sick. Although the results may be twice as high from morning to night, the variation is usually much less.

The CD4 percentage varies much less, and when I see a significant change in the absoulte CD4 count I will always look at the percentage to see if it has also changed. If it has not, I will repeat the CD4 count before concluding that immune disease progression has occurred. It may just have been that the CD4 count was measured at the wrong time and has not really changed.



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