Third set of labs -- comments?

[lydgate]

First labs (six months after infection), February 2006: CD4 757, CD4%age 38, VL 70 copies.

Second labs, July: CD4 917, CD4%age 40, VL 53 copies.

Third labs, December: CD4 515, CD4%age 38, VL 500 copies.

Not on HIV meds.

So: between second and third labs, CD4 absolute has dropped by 400, though the %age has remained relatively constant. And my VL has gone from virtually undetectable to a nice (ha!) round number of 500.

[That round rumber has me mildly (and unfairly) suspicious: I went for the blood draw on the 13th of this month, and the CD4 results came in very soon, in less than a week. But for some reason the VL blood vial wasn't examined/analyzed/processed until this week, even though the lab had done three VL batches between the 13th and this week (yep, I checked). Probably means nothing, but illogical/inexplicable delays like this make me curious and nervous.]

Of course I'm kinda disappointed, if not exactly worried. Don't really know what to think about this.

Jay

[newt]

This is a stable infection for the time being (there's lies, damn lies and lab results  )

- matt

Now playing: Supafly Inc., Moving Too Fast

[lydgate]

Oi Matt! The first clause of your sentence made me smile, the second and qualifying clause made me wrinkle my brow, and the parenthetical quip made me smile as well as frown.    You evoke complex responses.

Jay

and now playing is a "Simpsons" re-run, on low volume

[Tar Heel]

My CD4 count has raised and dropped almost 500 points in a short period of time.  My ID doc says the % is more of an indicator.   38-40% like yours is great.  I've been infected 18 months and on no meds and mine runs 32-33%.

[MSPspud]

Your numbers are awesome and the changes have not been statistically significant in terms of viral load and percentage.  You're still in the running for being a true LTNP.  I would rejoice at the trend.   

[lydgate]

Thanks, Tar Heel and MSPspud, for your responses.

I'm curious about whether the absolute CD4 count fluctuates more when the number (and the percentage) in general is on the higher side (>500) or when it's on the lower side (<500); taking 500 as a semi-arbitrary count. Does my question make sense?

Two apparently contradictory statements from doctors on thebody.org:

Dr. Holodniy in 2000: "cd4 fluctuations are usually larger when the absolute count is < 500."

Dr. Sherer in 2004: "Large fluctuations in CD4 cell counts are more common with higher numbers of T cells, i.e. 500 or above."

The links:

http://www.thebody.com/Forums/AIDS/Labs/Archive/Relationship/Q5520.html

http://www.thebody.com/Forums/AIDS/Resistance/Archive/general/Q158391.html

Holodniy's comment is nearly seven years old of course; and even Sherer's is two-and-a-half years old. Any "received wisdom" that's more recent, on CD4 fluctuations and their ramifications (or non-ramifications)?

Jay

[Eldon]

Yes, I AM Supporting You!

Hey Jay...

In the beginning your numbers will fluctuate a bit until some form of stability takes place with your system. Your numbers are looking good without the meds. Please do keep us posted.


Take care of YOU!
 

Don't You Dare Give Up... Don't You Dare Give In...

BECAUSE It IS ALL Within YOU to WIN!!!

[Coffeechick88]

I don't know about the >500 or <500 conundrum, but I do know the absolute CD4 number fluctuates more than the percentage.  The percentage is more stable, so that is why if you have a huge fluctuation, part of the picture also needs to include the CD4 percentage.  The first thing needed to figure it is a CBC.  We get the total white count, figure the absolute lymphocytes from that (total WBC count x lymphocyte %).  I won't go into all the aspects of flow cytometry, but we get a percentage of those lymphs that are CD4 (absolute lymph count x %CD4=absolute CD4). 

Anyway, the absolute fluctuates more while the percentage of the lymps that are CD4 is more constant.  For example, the CD4 count tends to be lower in the morning and higher in the evening, so if you got your blood drawn the morning one time and then the next time decided to go later in the day--the time of day alone can affect it.  If you have an infection, that can affect it.  If you, say have to go on prednisone for some reason, that can affect it.  Also, as Eldon said at first it can bounce around anyway.  So basically anything that affects any of the variables--the total WBC, total lymphocyte count (the number you take the % CD4 from) can make the CD4 bounce around. 

Do I make sense or say anything remotely helpful?  I am not always the best at explaining things, so hopefully I didn't confuse anyone (I tend to do that sometimes). 

Oh and as for the delay in viral load.  It could be they had a huge backlog or the tube got placed on the wrong rack or the tube got packed away by mistake instead of being run.  I have come into that situation where I see a test pending and then have to go tube hunting--very fun and one of the few things that make me start swearing.  Many things could have happened, but labs aren't always logical places. 

[lydgate]

Thanks coffeechick. And you can educate me on flow cytometry anytime!

Reply from Dr. Holodniy:

http://www.thebody.org/Forums/AIDS/Labs/Current/Q180862.html

Jay

[Strayboy74]

Jay-

You're doing fine.   CD4's can go up or down several hundred, based upon what time of the day it is, whether you've recently been ill, what food you've eaten, whether you've smoked some pot (AND THERE ARE STUDIES WHICH INDICATE THAT SMOKING POT HELPS TO RAISE THE CD4'S- BUT i DON'T REMEMBER THE SPECIFICS).

I'm waiting for my VL, but my T4's are at 374...  they've never, ever, even during the worst of my bad behaviors, dropped below 350.   Your percentage is a bigger indicator. 

 

-joseph