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Author Topic: CD4 Percentages  (Read 5414 times)

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Offline wolfter

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CD4 Percentages
« on: January 15, 2011, 04:05:26 PM »
I'm finally getting well enough to study and comprehend about these percentages but am a little confused on a couple of things and couldn't find the answers anywhere and I'm sure the wealth of knowledge here can answer me quicker than my continued searching.

The first I ever heard of percentages was my first labs after I switched to my current ID doctor (October 2008).  By then, I was too sick to think, let alone remember.  CD4; 69, VL; 6.7 million, and % 4.7 and was diagnosed with crypto at the same time.  I've steadily watched my numbers get better and my latest results show a CD4 of 438, VL 30 and the % at 18.2

The percentage has remained pretty constant over the last year.  From all I read, I should still be majorly concerned about my immune system.  Any thoughts?
productivity breeds content

Offline BM

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Re: CD4 Percentages
« Reply #1 on: January 15, 2011, 05:15:14 PM »
I remember reading somewhere that a CD4 percentage of 14 is roughly comparable to a CD4 count of 200 (with regards potential for developing illness). As you can see from my signature, my CD4 percentage has mainly been in the teens for about two years. I've been without illness all that time. I wouldn't worry too much: your numbers are headed in the right direction.

Offline wolfter

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Re: CD4 Percentages
« Reply #2 on: January 15, 2011, 05:33:31 PM »
I just always looked at the CD4 number until I started tracking the percentage.  From what I was able to read so far, even if your CD4 is over 1000, you could still have a problem if the percentage is under 30.  It's an indicator that there are still immune response issues.

Thanks for you response.  I don't get too worked up or worried about much these days, just trying to become as fully aware as I should have been for the last 20+ years.

Greg
productivity breeds content

Offline Jeffreyj

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Re: CD4 Percentages
« Reply #3 on: January 15, 2011, 06:36:03 PM »
I have never paid any attention to percentages. Unless someone can give me a reason to, i will continue to ignore them. Just one less thing to worry about.  My Dr. has never talked to me about them either.
Positive since 1985

Offline phildinftlaudy

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Re: CD4 Percentages
« Reply #4 on: January 15, 2011, 06:53:03 PM »
Interestingly, there are many people who have reported that their docs don't talk about cd4%; however, when it is brought up to the doctor - most will acknowledge that it is a better, more reliable indicator of immune system health (as cd4 count can fluctuate by 100 or more points in a single day)... Here is some info I pulled (sorry for the length - you can always go directly to the link and read the whole piece on cd4 count and percentage).  In particular, check out the last paragraph below and last sentence (whch I bolded and underlined).  I track both - and my doctor has always told me not to worry about my count dropping a bit as long as % looks good:

http://aids.about.com/od/aidsfactsheets/a/cd4percent.htm

What is the absolute CD4 count?
The absolute CD4 count is a measurement of how many functional CD4 T-cells are circulating in the blood. The lower the absolute CD4 count, the weaker the immune system. The absolute CD4 count is measured by a simple blood test and is reported as the number of CD4 cells per cubic millimeter of blood. HIV-negative people typically have absolute CD4 counts between 600 and 1200 CD4 cells per cubic millimeter. HIV-infected people have counts that are typically less than 500, and people with AIDS can have 200 CD4 cells per cubic millimeter or fewer.

What is the CD4 Percentage?
CD4 percentage represents the percentage of total lymphocytes that are CD4 cells. The CD4 percentage is measured using the same blood test as the absolute CD4 count. Typically, HIV-negative people will have a CD4 percentage of about 40 percent, while HIV-infected people's CD4 percentage can be as low as 25 percent or less. To better understand the concept of CD4 percentage and absolute CD4, let's look at an example.
Say your lymphocytes are 10 apples in a basket. There are two types of apples in the basket; red ones, which represent CD4 cells, and green ones that represent CD8 cells. If five apples are red and five are green, then the CD4 percentage is 50 percent.


Why is it Important to Know the CD4 Count and CD4 Percentage
The CD4 count and CD4 percentage give your doctor a snapshot of the health of your immune system. The immune system needs CD4 cells to function properly. The more CD4 cells in circulation, the stronger the immune system. By knowing the absolute CD4 count, your doctor has an idea of the strength of your immune system.
As early as 1988, infectious disease specialists determined that an absolute CD4 cell count of less than 200 cells per cubic millimeter placed the person at risk for opportunistic infections. In addition to measuring the strength of the immune system, the absolute CD4 count in part determines treatment needs for the patient. If the absolute CD4 count falls below 200, the doctor knows the patient is at risk for opportunistic infections; the doctor may prescribe protective antibiotics for the patient. If the absolute CD4 count rises after starting a new treatment regimen, the doctor knows the medications are effective.

The CD4 percentage provides another clue to the health of the immune system. Because the CD4 percentage takes in consideration the total number of lymphocytes present, many feel the CD4 percentage is a more reliable indicator of immune system health. Let's again take our basket of apples example. Remember, our basket of 10 apples had an absolute CD4 count of five and a CD4 percentage of 50 percent. Say the basket now has 25 apples, five red and 20 green. The absolute CD4 count is the same - five. However, the CD4 percentage in the second example is only 20 percent (five apples out of 25 are red), indicating a much weaker immune system.

CD4 percentage takes in consideration factors which could cause a false high or false low CD4 count. If the absolute CD4 count is higher only because the total lymphocyte count is higher that does not indicate the immune system is stronger, only that there are more lymphocytes contributing to the absolute CD4 count. In our example, the absolute CD4 count of five didnít mean as much in the basket of 25 apples as it did in the basket of 10. The count was five only because there were more apples.

There is some debate as to which measurement is a better predictor of opportunistic infection risk. In some situations, CD4 percentage seems to be as good a predictor as absolute CD4 counts. A recent study by D.M. Moore and his colleagues, published in HIV Medicine in September 2006, showed that in the case of people with no HIV treatment experience, absolute CD4 count and CD4 percentage both could predict HIV progression. However, the same study found that when the CD4 percentage is less than 15 percent, CD4 percentage should be considered along with the absolute CD4 count when determining illness risk and when to start HIV treatment. Finally, a study due out in the February issue of Journal of Infectious Diseases suggests CD4 percentage is a better predictor of disease progression.

September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline wolfter

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Re: CD4 Percentages
« Reply #5 on: January 15, 2011, 08:15:32 PM »
I found that same article during my studies.  For me, I don't want to be an ostrich with its head in the sand patient any longer.  I guess it's wanting to FINALLY taking full responsiblity for my health and understanding the issues.  I've not questioned my dr yet, but I'm wondering if there are underlying issues with this low percentage number.  I lived with this disease for 20 years without even knowing about that aspect. 

I understand the relationship of the numbers, but what does a prolonged low percentage indicate?

Thanks!
Greg
productivity breeds content

Offline phildinftlaudy

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Re: CD4 Percentages
« Reply #6 on: January 15, 2011, 08:24:51 PM »
I found that same article during my studies.  For me, I don't want to be an ostrich with its head in the sand patient any longer.  I guess it's wanting to FINALLY taking full responsiblity for my health and understanding the issues.  I've not questioned my dr yet, but I'm wondering if there are underlying issues with this low percentage number.  I lived with this disease for 20 years without even knowing about that aspect. 

I understand the relationship of the numbers, but what does a prolonged low percentage indicate?

Thanks!
Greg

I definitely think that you are taking the right approach Greg.  My doctor is always happy and impressed that I ask questions and that I want to know my cd4% as well as count - she gives me copies of my labs each time.  I would not really know what to say about a prolonged low percentage - I would think that if it is holding steady and your not having any health issues then it is probably nothing to worry about.  It can take a long while for the % to move up.  Considering the low % you had back in 2008, your % has actually went up pretty substantially.  Most people that I have talked to and that my doc has relayed info to me about max out around 40-43% (which is about what a non-HIV+ person has).

I'm not sure if you mentioned this previously, but what meds are you on and do you have any other health issues going on that might be keeping your % lower?
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline wolfter

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Re: CD4 Percentages
« Reply #7 on: January 15, 2011, 08:46:18 PM »
Thanks, I'm pleasantly surprised.  I won't post why pubicly.  My previous old ass id doctor dismissed every concern I had and I got to spend 5 minutes with his every 6 months.  Stupidly, I accepted his words as he was god and I was the patient.  I pretty much knew we were breaking up when I had lessions over my entire neck, armpits, arms and groin.  He said he saw nothing "remarkable". 

I wish I could post the name of my current ID doctor from Ohio who is beyond a doubt my hero, not just because he szve my life but because he is great.

I'm currently on Intelence, Truvad, and Isentress and havent had any major issues lately.
productivity breeds content

Offline phildinftlaudy

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Re: CD4 Percentages
« Reply #8 on: January 15, 2011, 08:50:52 PM »
Thanks, I'm pleasantly surprised.  I won't post why pubicly.  My previous old ass id doctor dismissed every concern I had and I got to spend 5 minutes with his every 6 months.  Stupidly, I accepted his words as he was god and I was the patient.  I pretty much knew we were breaking up when I had lessions over my entire neck, armpits, arms and groin.  He said he saw nothing "remarkable". 

I wish I could post the name of my current ID doctor from Ohio who is beyond a doubt my hero, not just because he szve my life but because he is great.

I'm currently on Intelence, Truvad, and Isentress and havent had any major issues lately.

I'm glad you have a doctor that you are establishing a good relationship with - I believe that is so important.  My doctor is with University of Miami and she is great - I usually spend about an hour with her every three months - we talk about everything and she will pull stuff up on the computer while I'm there and we go over it, etc.

I'm sure you will continue to see increases in your % - they may be small - but with %, even small increases of 1% or 2% are significant (IMHO).
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline eric48

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Re: CD4 Percentages
« Reply #9 on: January 16, 2011, 05:25:40 PM »
Hi,

I'll make it short cause it is past midnight:

The not-so-good news:

- some (limited) people have a CD4% that lingers around and below 20% after YEARS of treatment and statistically (but YOU are an individual...) this situation is a marginal but real additional risk factor
- current science does not know what to do ... there is current, ongoing research on this subject, but no 'solution' has emerged thus far.

The good news:

- despite slow, your global trend to CD4% increase is positive, so you do not really qualify for the situation I described above.

Eric

Offline elf

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Re: CD4 Percentages
« Reply #10 on: January 17, 2011, 01:00:46 AM »
My doctor told me CD% is diagnostically important these days only for
1. deciding when to start treating kinds (if CD4% is above 18 therapy is deferred)
2. for understanding sudden CD4 changes (if your CD4 drop from 1200 to 600, but CD4% has not changed you're fine)...

--
CD4% was more important in the preHAART era, that's why some (or most) European infectologist say CD4 number is a better predictor of immune health.
« Last Edit: January 17, 2011, 01:02:49 AM by elf »
Let's have a Kiki!

Offline tednlou2

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Re: CD4 Percentages
« Reply #11 on: January 17, 2011, 03:08:43 AM »
From Dr. Gallant in an answer about percentages: 

On Sep 29, 2010 Joel E. Gallant, M.D., M.P.H. Joel E. Gallant, M.D., M.P.H. replied:

--------------------------------------------------------------------------------
The CD4 count/percent correlation is not a perfect one, and there are plenty of people like you for whom the numbers don't seem consistent. In general, the CD4 count is felt to be more important (though more variable) than the CD4 percent. But once your viral load is undetectable and your CD4 count is above 500, your focus should be entirely on the viral load. At that point, the CD4 count and percent really don't matter anymore. I've started measuring them no more than once a year in such people.

Offline Miss Philicia

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Re: CD4 Percentages
« Reply #12 on: January 17, 2011, 09:03:18 AM »
I've had five different HIV ID specialists over 17 years, and all of them paid attention to the cd4% just as they did the absolute cd4 count (and of course viral load) -- all three provide an accurate picture when viewed together.  Obviously you'd rather have a patient with a cd4% of 50 than 14.

ps: my cd4% is 50 :)  but then I'm the living embodiment of HIV perfection.

Also, Monsieur Gallant is not Jesus.
"Iíve slept with enough men to know that Iím not gay"

Offline eric48

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Re: CD4 Percentages
« Reply #13 on: January 17, 2011, 11:27:06 AM »
CD4 are a type of lymphocytes.

Same as in financing...

If you have no or little cash (CD4) it does not matter what your financial structure is. Especially if you are close to bankruptcy.

Once you have some (either $$ of CD4) then a financial adviser looks into the portfolio structure (bonds, stocks...) and looks happy when you have a lot ($ or CD4) and happier
if, having a decent number, the portfolio is well balanced.

For a rich person, to have all assets in cash and no longer term, safe, investments, is not as satisfactory as having even a bit less, but better structured.

The CD4% (and its companion CD8%) gives a view of what the portfolio is made of.

Hence its importance for those who have, and lesser importance for the have-nots.
And for those under treatment, the relative significance of a good or less good % depends on where you are on the timeline.

Therefore it is confusing to talk about the importance (or non-importance) of CD4%, per se, out of context.

Same with CD8% (by the way), to a lesser extend.

Hope this helps clarify

Eric

 

Offline phildinftlaudy

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Re: CD4 Percentages
« Reply #14 on: January 17, 2011, 01:42:58 PM »
I'll continue going off cd4%, cd4 count and VL --- especially since like Ms. P, I have had three different ID docs and they all felt that cd4% was an important part of the equation.  The more information one has the better the picture, the better the decisions that can be made (Knowledge=Power).

I don't just want to know the amount of $$ I have in my checking account - I also want to know my savings balance, my incoming cash, upcoming expenses, and overall cash flow ---- helps me have a more accurate financial picture and budget accordingly.
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline jkinatl2

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Re: CD4 Percentages
« Reply #15 on: January 17, 2011, 02:33:36 PM »
The more information one has the better the picture, the better the decisions that can be made (Knowledge=Power).


This.

Also, I haven't had 500 CD4 cells since 1995. At levels below (the fantastic and statistically normal) 500, a person would be an idiot to ignore percentages (and any other element of blood work). Which is not to say I have never been/am not an idiot. But idiotic behavior with the self-awareness of such is markedly superior to simple willful ignorance.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline wolfter

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Re: CD4 Percentages
« Reply #16 on: January 17, 2011, 06:31:24 PM »
Idiot's kinda strong.  maybe even the old dogs want to learn some new tricks. 
productivity breeds content

Offline numbers

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Re: CD4 Percentages
« Reply #17 on: January 17, 2011, 09:31:48 PM »
As I understand it, CD8's are included in the cell total from which CD4% is determined.  Untreated HIV causes CD8 counts to increase for reasons that are not fully understood.  Once treatment starts, CD8's start to decrease to more normal levels and so the CD4% will increase as a result, even if the absolute CD4 cell count stays the same.  This is what seems to have happened at my case - from May to December my CD4 count stayed the same but the CD4 percentage increased from 23% to 36% as my CD8 count went down to a normal level.  Latest test last week showed CD4 count jumped to 450 and CD4% is 39 so I'm happy now :)

So you might want to look at your CD8 count in conjunction with your CD4%.
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

Offline elf

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Re: CD4 Percentages
« Reply #18 on: January 18, 2011, 08:39:28 AM »
I've had five different HIV ID specialists over 17 years, and all of them paid attention to the cd4% just as they did the absolute cd4 count (and of course viral load) -- all three provide an accurate picture when viewed together.  Obviously you'd rather have a patient with a cd4% of 50 than 14.

ps: my cd4% is 50 :)  but then I'm the living embodiment of HIV perfection.

Also, Monsieur Gallant is not Jesus.

But Dear Miss Philicia, has your cd4% has always been that high?
Or it was low, but it has returned to the normal values with medication?
Please reply.
Hugs  :-*
Let's have a Kiki!

Offline Miss Philicia

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Re: CD4 Percentages
« Reply #19 on: January 18, 2011, 01:01:29 PM »
But Dear Miss Philicia, has your cd4% has always been that high?
Or it was low, but it has returned to the normal values with medication?
Please reply.
Hugs  :-*

Of course it's not always been that high -- I started off my diagnosis with actual AIDS. My lowest % was 14% in 1994.  I actually still have copies of my lab numbers from the first year or two, after that I stopped keeping most of them until around six years ago.  So at the end of 2004 they were "just" at 31% but at that point I still had a detectable viral load of ~25-50,000.  Once my treatment was sorted out and I was undetectable, then my % went to ~40% (early 2007) then kept slowly increasing until I hit 50% last July.  That's my highest, last labs it went down to 49%
"Iíve slept with enough men to know that Iím not gay"

 


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