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Confusing blood tests and starting therapy
Oct 23, 2002

Hi, thanks for all the great advice. I tested positive about a month ago and since then have had 2 sets of blood tests. The first showed a viral load of 112000 and a CD4 count of 225, while the second showed a viral load of 47000 and CD4 count of 274. My CD4 percentages were 19.1 and 26.6 respectively. After my first set of results, I was under the impression I should start treatment right away due to the low CD4 count. But I have just got the second set of results today, and the doctor said that although my CD4 count is low, my CD4 percentage is quite healthy so there is no need to start treatment immediately since my low count probably only indicates that I had a low lymphocyte count to start with (before infection). What do you think? I am also confused as to why the viral load has fluctuated so much. I am presently healthy and have never had any opportunistic infection.

Response from Dr. Young

Thanks for your question and comments.

There is a lot of variation in HIV lab tests from day to day-- for example, there can be a 3- to 5-fold variation in viral loads. There are variation in viral loads as a function the the time of day, and due to immune stimulation (vaccinations, for example). In clinical studies, the way that this is handled is to average two or more values obtained before treatment is started. From this one can probably safely assume that the difference between 112,000 and 50,000 might simply reflect normal variation.

As for your CD4 cell count, I agree that the differences between 19% and 26% seem somewhat larger than expected-- again this might represent variation (since I usually don't expect to see differences greater than 3-5%). What explains this isn't obvious, but I'd hate to make the decision to start therapy or not on the basis of a single test (in your case, the test with the higher percentage).

I'd probably stress that the need to start is not urgent in most cases (including yours), but that with a careful understanding of the risks of starting and the risks of delaying therapy and a sense for the trend in changes, a more accurate assessment can be made. There is no absolute CD4 count value that triggers this decision, but it looks like starting therapy is probably in your near- to intermediate-term future. I hope that this is helpful to you. BY

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