Question Regarding CD 4 count???

[OddlyEven]

Hey everyone, not sure if this is the place for this question but it's the only forum that seemed appropriate. I've posted here before (sporadically) and I usually get good answers and advice here. So here's another question:

I'm HIV positive.The last three blood panels I've had run have shown the virus as undetectable and my CD4 count has been over 1000. Last week I had another series of test run and it showed the virus was undetectable once again but my CD4 count had dropped to 900. Is this normal? Should I be worried?

[Nashvegas]

Nope, no need to be worried.  Those are great numbers and the difference between 1,000 and 900 is not significant.  We're all very jealous.  ;-)

[weasel]

  NOPE , We all envey you 

     It is common  to have a " blip " once in a while .


                        Be well , be happy ,
                                                                  Carl

[John2038]

0 needs to worry.

I also get CD4 1015 and 844 the week just after. But the CD4% haven't move, which is the most important things to look at to appreciate a CD4 variation.

weasel:
it can be a blip if we define it as a VL in the hundreds. And OddlyEven is undetectable.

[OddlyEven]

Really confused by the last reply. But thank you all for replying. Since I got the virus, I've worried a lot about it. I had gotten a little comfortable with it...maybe too comfortable since it's been undetectable for almost two years...hell thinking about it now...it's going on three years. Still when the nurse told me about the drop in CD4...that kind of woke me up a bit. Are they going to continue to go down? Is this it for me?

Anyway...thanks.

[leatherman]

cd4 counts go up and down all the time. Being fatigued, depressed, happy or energetic can make a change in the cd4 count hour by hour or day by day. Now if your VL changes by hundreds  or so, that's commonly known as a "blip", and can be more problematic as it could be the evidence of a med failure or need for meds. The best way to really evaluate your numbers are by the trends over 2-5 times or so. If by chance your cd4 would continue to drop and your VL begin to increase, then you might have something to be concerned about.

(john's referring to, I think, the cd4/cd8 ratio as the %. I've never bothered in nearly 2 decades to really even care or track that number - that's why I can't even pretend to really know what that percentage measures. LOL  but what he's driving at is that even though you may have had that "absolute" drop in count, the percentage might not have changed at all in the ratio, so the drop really means nothing. what it comes down to is, dude you're undetectable with 900 tcells? There ain't a damn thing wrong with that at all!!)

having myself only peaked over 300 twice in 17 yrs, I'm a little jealous of that count too. But the average 175 tcells that I have had do seem to be doing the trick as I'm coming up on 12 yrs since I was last in a hospital. It's never about how many tcells you have - it's all about how well they do their job

[J.R.E.]

Still when the nurse told me about the drop in CD4...that kind of woke me up a bit. Are they going to continue to go down? Is this it for me?

Anyway...thanks.

Hi there,

As leatherman states, your CD-4 count fluctuates on a day to day basis.  The thing to watch is the trend in numbers, over a period of time, but overall I would say your doing pretty well.

How often do you go, for your blood tests ?

Take care----Ray

[John2038]

OddlyEven

sorry if I have confuse you.
The CD4 count are bouncing a lot. Typically lower in the morning, higher in the afternoon.

Your body is not a like a company producing always a given amount of cells every seconds. His production fluctuate, in healthy persons as well.
You have to look at the CD4% if you want to know if overally speaking, the absolute change in your CD4 are real or related to the normal variation of the production in the body.

Let say your body is producing 2 cells: blue and green.
Let say you are having 1000 blue cells and 1000 green cells.
So the blue cells percentage is here 50%

Let say the day after, the total production is 700 blue cells and 700 green cells.
Still, the percentage is 50%.

As long as the absolute count is within the normal range (let say 500-1500),  with 700 or 1000, you are fine, like any healthy people.
And you can confirm it by looking at stability of the percentage: if it haven't move by few %, you are fine.

At your next blood draw, your body will maybe have produce more, maybe less than in your last blood draw, and if the percentage haven't move, you will see your absolute numbers bouncing.

Now about the CD4 and CD4%, we like to see an increase of the production with the time, because we like to be as far as possible to the lower range. But again, the normal range is 500-1500.

As the total lymphocyte count have a range too (typically 1-4 x10^9/L), and as your CD4 are part of these lymphocytes (30%-60% in healthy people), you won't be able to see them increase indefinitely. But you will gain more gaining some CD4%.

Another way to look at how healthy is your immune system is the CD4:8 ratio.

About the VL,  undetectable means that you have reach the lowest possible level of bugs in your blood, and as such, it is causing now the lowest possible dammage it can cause.

When you reach this level, it means that the drugs are working.

So looking only at the absolute CD4 only is just telling you that you are human, in more, in your case, a human that is doing very well.

[leatherman]

Thanks John! (it's always good to hear from you) That was very informative and got me un-confused me about some things. Because I'm at the end of the spectrum with so few tcells and have already lived for 17 with AIDS and didn't know my percentages, I'm still not going to ever worry about that stuff, even though you explained it quite nicely. LOL

best wishes to you oddly/even with your incredible counts of 0 VL and 900 cd4!

[tednlou2]

Have you considered being a part of elite controller study?  If you've been poz for a few years and vl is always undetectable, then you should consider it.  I don't thing you mentioned you're on meds, right? 

About CD8--whenever I ask any doc about it, they say they don't use that and I shouldn't worry about it.  About CD4, I recently read a question to an HIV doc about the best way to test CD4.  He was saying a more accurate measure of CD4 would be to draw blood/tissue from a lymph node.  He was saying the blood out of a vein only has so many CD4 cells depending whether they are being called away to fight some infection or something.  That would hurt bad I think

[Rev. Moon]

Have you considered being a part of elite controller study?  If you've been poz for a few years and vl is always undetectable, then you should consider it.  I don't thing you mentioned you're on meds, right? 

I was about to ask the same question as Oddlyeven does not mention meds.  If that's the case then these values are excellent and nothing to be stressing about (the minor drop that is).

I like to ask about the CD4% and my doc discusses it, but she tends to focus more on the absolute value.

[Ann]

I don't thing you mentioned you're on meds, right? 

I was about to ask the same question as Oddlyeven does not mention meds. 

He told us he is on meds in his very first post.

To read any member's posting history, go into their profile and click on the show posts link found there. Simple.

Ann

[leatherman]

He told us he is on meds in his very first post.

Doh! Thanks Ann. I didn't know either, so I worded my post very non-committedly ("evidence of a med failure or need for meds") around that issue. I do look at people's past posts usually; but was hoping someone else would get a response and I wouldn't have to click around to find out. LOL leatherman was having a lazy day today. ROFL

[Boo Radley]

In the Olden Days the general wisdom applied "normal" to CD4 counts of 800 and above.  As John said the other important CD4 measure is the percentage which my doc totally ignores even though I ask what it is each time.

A CD4 count of 500 is still in the normal range albeit at the lower end.  The real question is if you have had any OIs (opportunistic infections, of course) or other indications of immune system compromise.  I've known people whose CD4 counts were in the low 2 digit range yet somehow they remained healthy (using past tense simply because I no longer leave my womb-home if I can avoid it, thus see far fewer people)

Since you are on meds everything looks great.   I am/was sort of in a mid-range category between elite controllers and typical diseased pariahs, which I've labeled long-term slow-poke progressors.  My last CD4 count was 168 or something ludicrous but my vl still undetectable.  If I had gotten blood work done at the beginning of November as instructed (my doctor gets really pissed at my procrastination but he can go frock himself...) I've no doubt it would be back in the 300 range where I've hovered since 2005.   My viral load has never exceeded 57,000 (i.e., since the v.l. test became standard procedure -- god only knows what it might have been in the early 80s when I became infected)  so I've never been too concerned.   Again, I rely on my overall health and not just lab numbers but my labs have always been good enough for me (even with CD4 <200) because my feisty old body has never encountered an HIV/AIDS related condition.   My advice applies only to people who have had no signs of immune breakdown because even with a higher CD4 count some people get PCP or Kaposi's Sarcoma or something equally hideous.

Just keep doing whatever healthy activities you've been doing and if, oh, let's say you're a total a-hole like me you start ingesting a lot of questionably manufactured GHB or are using alcohol or any recreational drug, SLOW DOWN!!  Better yet, stop. 

[joemutt]

my cd4 count has been going up and down between high 700s to low 1500s in the last few years,
mostly around 1100. While it never worried me, I'm looking to reduce stress nowadays to see
if I can stabilise the number. I have been on meds since diagnosis (12.5 years).

[Rev. Moon]

He told us he is on meds in his very first post.

To read any member's posting history, go into their profile and click on the show posts link found there. Simple.

Ann

Oops, my bad, dear almighty Ann... I [normally] make sure to check past entries, but the thought of doing any archaeological digging didn't cross my my mind this time.  Thanks for pointing us in the right direction.

[leatherman]

I'm looking to reduce stress nowadays to see if I can stabilise the number

ah! therein lies the problem. you can't really stabilize a cd4 count - unless you have the blood taken at the same time of day every time, in the same frame of mind, having the same energy level each time. without having experienced any illnesses or extreme mental/physical highs or lows in the intervening periods, and then have it processed by the same person in the same lab. And after all that, there still wouldn't be a perfect guarantee that you'd get a stable number.

Since what you're really looking for is a trend of how your counts are going, that means you're actually looking for a range of numbers. Over 17 yrs, my cd4s, once I factor out the lows of 5 and 7 when I was hospitalized with OIs and the highs of 305 and 311 that had to just be flukes, I get a range of 150-265.

You say your range is 700 - 1500 with an avg of 1100. Maybe reducing some stress might tighten up that range to 900-1400; but you'll get a more "stable" range by making sure each test is as near as possible identical to the last time. I'm glad you said you weren't worried as those are great numbers too! (too often around here, it seems the people with the best numbers seems to be the ones to worry the most. LOL)

Plus everyone needs to realize a majorly important issue when considering their cd4 count. Do you actually know your baseline cd4 count BEFORE you were infected?? For all I know my baseline was only 400 and that's why my count has never "recovered" very high. Knowing the "normal" range is 500-1500 doesn't tell you what your "normal" range ever was before HIV.

The clinic/ASO that I use does a lot of HIV testing over a tri-county area. They always suggest to the people that come in and test neg, to get a baseline cd4 count taken. That way, if heaven forbid, later on they should be dumb enough to get infected, they will have more data for themselves and their doctors when monitoring their treatment.

[OddlyEven]

Thanks again everyone, you're all so knowleable about this, I guess I have to learn to cope and deal with this and learn more about as time goes on, as I said, it's only been three years for me.

Yes, I'm definitely on meds...Reyataz and Truvada...and so far that combination really kicks some virus butt!

My doctor only has me do blood work twice a year, usually it's at the beginning of the year and at the midpoint of the year (in July). So I guess I won't know what my CD4's are until then, I just hope they don't continue to go down.

Thank you all for being so nice to me and sharing your information with me. Much appreciated!