LABS-CD4/VL/CD4%

Question

Dear Dr. Bob, I hope everything is well with you..it has been ahile since i had last posted to you with a question...

I recently have noticed since my diagnosis of hiv in Feb of 2004 that when i go for my labs(every 3 mmonths)..the numbers change, sometimes so drastically..is this typical with hiv infection? Why does this happen? My last labs were done on 6-2-04 and reflected cd4 at 612, vl at 14,000 and cd4% at 25....in March of 2005 my cd4 was at 712, vl at 22,000 and cd4% at 23-24%...So what i am really asking is why(with no infection or ilness noted) would theses numbers jump as they did and when should i begin to worry about starting treatment???? I have not yet started any meds for the illness! I ThankYou in advance for taking the time to read my question and giving me your honest input...also, while your at ithahaha if you could please explain to me how quickly You feel , as a doctor, i have before starting med treatment? In the past my numbers have ben pretty stable with the highest vl being 55,000 when first diagnosed(has not gone back to that since diagnosis)...cd4 generally run within (well now)612-780 nad prcent of cd4 has been 23-25....???? Thanks Dr. Bob and looking forward to your responses....

            *Jessica*

Answer

Hi Jessica,

Absolute CD4 cell counts can vary up or down within the normal range for a wide variety of reasons. CD4 cells are involved with many facets of the immune system and not just reflective of HIV. The CD4% is less sensitive to these fluctuations than an absolute CD4 cell count. Your CD4% has been reasonably stable in the 23-25% range.

The HIV viral load can also be variable in untreated HIV-positive folks, as it represents a tenuous equilibrium between the virus's ability to infect cells and reproduce versus the body's ability to try to keep the virus in check by a variety of immunological mechanisms.

When should you consider starting HAART? Most guidelines would suggest you should consider starting treatment when your CD4s fall consistently into the 250-350 range.

Falling below 200 CD4 cells (or a CD4% of 14%) places you at increased risk for opportunistic infections, so we want to avoid that if possible.

How long will it take you to reach the treatment threshold? No one really knows. In general, untreated HIV-positive folks drop 50-70 CD4 cells per year; however, this certainly is not absolute, and there is great variability from person to person, due to different viral strains, different immune responses, concurrent illnesses, etc. That's why we suggest monitoring your CD4 cells and viral load every three months.

Stay well.

Dr. Bob