Discordance absolute and percentage CD4

Question

Dear Dr. Holodniy, My last two-year results are the following:

Nov. 2011: CD4 504 39% CD8 765 60% June 2012: CD4 677 39% CD8 980 57% Nov. 2012: CD4 673 34% CD8 1,140 60% July 2013: CD4 457 42% CD8 588 53% Nov. 2013: CD4 468 37% CD8 710 54% Currently not on meds. VL 4,813 copies/mL

I do not understand the discordance between absolute and percentage of CD4 counts. My doctor says counts are fine, but am not sure so, because my CD4 absolute seems to be declining yet absolute numbers seem to be ok. Please give me your advise. Thanks so very much.

Answer

In general, I agree with your doctor. Given that you have a low but detectable viral load, the infection is active and could be associated with a mild CD4 count and percent decline. Taking the long view, your average CD4 count is 555 and percent is 38.2% over the last two years, so there has been no significant change in two years. This all said, it does need to be watched and if the CD4% starts declining to the low 30s you may want to consider starting HIV treatment.