High CD4 count, Low CD4 %

[LM]

Hi guys,

I'm a bit confused. Initially, I reported here my CD4 % was good, but it was actually low. The first one was around 23% and the last three exams have been under 20% - 16%, 17%, 16%. My CD4 count has been somewhat high and stable, around 600-700. And so my last numbers I got today were CD4 610, 16%. VL around 30,000.

Here, they only consider the CD4 count to start treatment, not the %, so my doctor said I shouldn't worry about it, even though this is not normal, and that it will probably be a few years until I need treatment. So I wonder: am I in a vulnerable situation healthwise, should I be worried? Ideally, should I start treatment?

Thanks.

[Miss Philicia]

Technically, a % above 21% indicates a healthy immune system regardless of real cd4 count. A % below 13% regardless of real cd4 count usually means that the immune system is damaged and you should at least consider prophylactic treatment for things like PCP.

linky

I'd not worry about it for now.

[newt]

Or technically not, neither US nor UK guidelines refer to CD4% as a measure of when to start treatment or method to monitor immunity long-term, except for special populations eg people with no spleen, HTLV-1 infection, where the count may be artificially elevated (or depressed eg long-term steroid use).

- matt

[spacebarsux]

Although I wouldn't worry myself if I were you, I'd personally start seriously considering beginning therapy since the low CD4% is indicative of an overworked and struggling immune system. (But if your doctor thinks otherwise, then  maybe I'm overthinking it  )

This link (http://i-base.info/ttfa/section-1/19-interpreting-cd4-results-cd4-count-and-cd4-percentage) from the i-base site states as follows:

•A CD4% of 12-15% is about the same as a count of under 200 cells/mm3.
•A CD4% of 29% is about the same as a count of over 500 cells/mm3, but there is a wider range for higher values.

Going by the above, 16% seems precariously close to the 12-15% region and even though your absolute CD4 count is >500 and thus nowhere near 'very immuno-compromised danger zone', your percentage isn't as comforting.

If I were you, I'd begin mentally preparing myself and probably discuss things a little more with my doctor.

Best.

[newt]

Very true the above. According to John Hopkins the approximate range of CD4% by CD4 counts are: over 500 CD4 count, over around 29%, 200-500, around 14-28%, under 200, around 14%. ref

All the evidence points to CD4 count being the most useful marker for risk of opportunistic infections, when to start treatment, unless the % is very low (which 16-17% isn't). Which is why guidelines refer to CD4 count for treatment decisions.

- matt

[LM]

Thanks, guys.

Yes, I've read that a CD4% of 12-15% is like having 200 cells/mm3, but what got me confused is what does it mean when you have, let's say, 15% but 500? Do you look at the %, at the total count, or balance both out? My doctor said it's unusual, but that I shouldn't worry about it, the total count that really mattered, and that I wouldn't probably need treatment for a few years. But if newt said the CD4 count is a more useful marker, then I feel more relieved. The good thing is that, so far, after 1 year (and if I recall correctly, I started having ARS symptoms at this day exactly one year ago), the exams have been stable.

As for the idea of starting treatment, I wouldn't like to do it now because I'm dealing with other things at the moment, so it wouldn't be good for me personally. Not so much afraid of it, just not a good time. The guidelines here wouldn't allow it as well. But, despite that, my doctor did ask me if I wanted to be enrolled in the START study, since I filled the criteria they were looking for over there. Interesting idea, but like I said, not a good time right now.

[newt]

I'd look at the CD4 count. Your CD4% is statistically low for your CD4 count but not super unusually so. And importantly both are stable.

Guidelines on treatment and risk of opportunistic infections are all based on CD4 count. If your CD4% goes under 10-12% on several tests then I would seek further investigations/discuss treatment perhaps, especially if your count has dropped under 500 on these tests too.

- matt

[LM]

If your CD4% goes under 10-12% on several tests then I would seek further investigations/discuss treatment perhaps, especially if your count has dropped under 500 on these tests too.

- matt

Yes, I was thinking exactly the same thing. If it drops below 500 and the % gets lower, I will discuss treatment. Thanks again, newt!