|CD4 Counts as Basis for Treatment Decisions
Feb 10, 2005
Thanks for citing your sources about CD4 count variations during the day.
Doesn't it bother you that the two studies contradict each other and that apparently no one has bothered to get a definitive answer to this in nearly 15 years despite CD4 counts being taken for hundreds of thousands of patients? What is to be done?
You emphasize using percentages and changes over time to make therapy decisions, but don't the treatment guidelines rely on CD4 counts and viral load?
Perhaps one should go on therapy if ones CD4 count is 200 at ANY time of day, but if there is a difference of 60 or 200 (as many sources say) between morning and night isn't this important?
Understanding the course of the disease and making comparisons between patients to test new treatments is difficult enough but if 60-200 difference can be caused by time of day we need to pin this down and consider it when researching claims about drugs that supposedly increase CD4 count by 200 points or when trying to figure out what having a CD4 count of 350 or 500 or 700 means for patient health/stage of disease.
| Response from Dr. Conway
The guidelines rely on CD4 counts as the criterion for treatment decisions and viral load as a means of predicting who will be experiencing a decrease in CD4 count more rapidly than others. The CD4 count and percentage ussually run together. However, if something is having a significant effect on the CD4 count (such as diurnal variation, immune activation, a serious illness, etc...) quite apart from HIV, the CD4 percentage is much less affected by these occurences and becomes a more reliable measure.
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