cd4 time of day count variation

Question

Doc Holodniy, I am an elite controller and am participating in all of the national studies. My VL is <50 and have never been on meds. Something that greatly frustrates me, is having to explain to EXPERIENCED DOCTORS that when my cd4 count is taken at 8AM, it is 400+ cells lower than when taken at 8PM. My cd4 count when taken at 8AM ranges between 400 to 550. When taken at 8PM, it ranges between 750 and 1000, but averages about 900 (+/-50). My cd4 percentage ranges between 48 to 54 percent (average 50%) and my cd8 percentage averages around 25% (+/-3%. My cd4/cd8 ratio ranges between 1.5 to 2+. In the studies I participate in, the blood draws are all done in the morning, and they record those cd4 counts as my max, which are much lower than my evening counts. My morning counts ARE NOT my maximum counts, which I seem to have to constantly explain. One well known researcher after comparing my evening results, (cd4 count 900+,) said it looked like I was progressing, when she looked at the morning count she took, which was 520. She said I had a huge drop, and thought I was progressing and might need to consider therapy to help control a further drop. Like many doctors I have encountered, few tend to take into consideration time of day, when looking at counts. If I did not have the opportunity to get my bloodwork done in the late evening, I never would have known my max cd4 count was so high. Doctors, researchers, and the government, if they are determining a person's progression rate by recording counts, HIV doctors and labs need to have late evening hours. Most HIV'ers do not know this fact, and some have probably been put on therapy or are walking around thinking they have low cd4's, or AIDS, when infact their diagnosis could be wrong and counts much higher, and may not need therapy due to ignorant doctors. I wish something could be done about this major problem. In NYC, counts below 500 are reported to the Board of Health as pre-AIDS. Some of my low morning counts have been registered with them. I am actually registered as that, if you can believe it, because they go by counts. How could statistics be accurate, if the testing is not done in the late evening? I have found they really care more about not having to work late, rather than trying to get a persons best counts. Low cd4 counts are actually normal in the morning for people not infected. Mine follow the normal pattern, and I'm sure there are many HIV'ers out there who are unaware they do to.

Answer

Yes, your observation of your own CD4 count diurnal variation is a real biological phenomenon, and we talk about it a lot in this forum. Just need to keep educating HIV practitioners and patients alike on the topic.