Question
What does my CD4 percentage mean?
7 January 2017. Related: All topics, CD4 and viral load.
Answer
Most information about how HIV affects your health comes from your CD4 count. This includes how HIV has damaged your immune system and how HIV treatment (ART) is making your immune system stronger.
The CD4 count is usually given as a number (usually between 1 to about 1600 cells/mm3).
This number is called the ‘absolute’ CD4 count.
However, many things affect this absolute number. These includes the time of the day, what you have eaten, if you have taken exercise, or if you have other infections. Each of these factors can affect your CD4 count but they are not related to immune system.
If your CD4 results are ever much higher or much lower than you expect, your doctor should look at your CD4 percentage (CD4%).
The CD4% can indicate whether this is a real change, or just a fluctuation. The CD4% is generally more stable.
The absolute CD4 count is still best at predicting risk of HIV progression.
The CD4% is the percentage of white blood cells that are CD4 cells. In an HIV negative adult the average CD4% is about 45%.(But this can range from 24% – 64%)
In adults, a CD4 percentage of 12-15% is considered similar to a CD4 count of 200 cells/mm3. A percentage of 15-20% is similar to an absolute count of 300 cells/mm3.
Babies and children with HIV are monitored using CD4%, because their absolute CD4 counts are much higher than adult counts, especially in the first few years.
CD4% may be an independent predictor of HIV disease progression, and a low CD4% should be considered as a factor in starting treatment, even when the absolute CD4 count is relatively ok.
This answer was updated in January 2017 from a question first posted on 8 October 2012.
Hi Jay,
If you have started Sustiva and Truvada these medications should help you to increase your CD4 count over the next few months. Your CD4 count is relatively good and the chance of you getting any opportunistic infections is low. You wouldn’t be described as having AIDS and so long as you adhere to treatment and it works well for you it is unlikely that your CD4 count will drop below 200.
You should report any side effects or symptoms to your doctor so that these can be managed.
Hi
I’m 27 and I just got diagnose positive two months ago but last test was 2years ago sn was negative then.. i got diagnosr with a VL of 150 and a CD 4 of 260 but then started suffering from a throat infection that was going around my village just as I started my meds.. I’m on sustiva and turvado. I’m still dealing with the nausea of starting these tablets and getting over this infection through antibiotics.. Wil my cd4 count fall dramatically now as I’m ill and I’ve heard that if it goes below 200 I got aids?? And if it does an then goes back up well coz of my meds does that mean I got hiv or aids?? Does my situation sound good?? Been on the meds a week now an notice my lymph nodes are swollen an a little bit painful.. Please help any info would be much appreciated..
Hi Andrew,
Why have you refused to start medication? Were you diagnosed recently, or have you known that you are HIV positive for a while?
With a CD4 count under 350 it is important that you think about starting treatment soon. This is because, while your CD4 count is this level, you are at higher risk of opportunistic infections that cause diarrhoea and weight loss. You can give yourself some time to learn about treatment though, as the risk is highest when your CD4 count is below 200. It is important that when you start treatment you are ready, and that you feel able to adhere to it and take it every day. You can read about CD4 counts and risk of illness here.
From the two CD4 counts you have provided it seems like your CD4 count is relatively stable. These two results would probably be seen as being the same by your doctor because CD4 count tests aren’t accurate enough for a difference of 13 to be significant. It is very important that you are getting regular monitoring though, so that you can quickly pick up if there is a drop in your CD4.
I refused medication.
4/11/2013 CD4 count 280 CD4 percentage 23%
7/26/2013 CD4 count 293 CD4 percentage 18%
Hi,
Thanks for your question. I’m sorry but I don’t know what the significance of a CD4 percentage this high would be. Are you HIV positive and do you know what your absolute CD4 count is? It’s a good idea to discuss this with your HIV doctor if you are worried.
What if the percentage is above 60%? Is that good or bad? I haven’t seen anyone talk about percentages over 50%, but on my paperwork it listed my % to be 78% after I had a blood transfusion so I’m wondering should I be worried or happy.
Hi Eric
I have not seen reported that link Atripla to a drop in CD4 count. This makes it unlikely that switching to an alternative treatment would make any difference. In general, there are no combinations that are better for your CD4 count than others. This is because the meds work at reducing viral load, and then your immune system gets stronger by itself. This is something you could try though if you wanted to.
It also sounds like your doctor is giving you good advice as your CD4 percentage is very good and in the normal range for an HIV negative person.
You could also ask your clinic or doctor for a second opinion, or for a recommendation or for whether this could be referred to an HIV immunologist, or discussed in a virtual clinic. This is where all the doctors in a clinic review difficult cases notes to brian-strom whether other options are possible.
I have been under treatment for HIV since 2001. My first regimen was zerit/lamivudine/sustiva. It worked sufficiently, but not as good as the Atripla regimen I am currently on. My WBC has fallen from the 7.0 range down into the 4.0-5.0 range and has been holding there for several years now.
My CD4 precipitously dropped from the 800 range about 4-5 years ago when I started atripla down to the 200-350 range, currently 270. This sudden drop occured about 2 years ago. My V/L remains undetectable long term and my CD% ranges from 37% to 42%. My ID physician feels that the CD% is a far more accurate predictor of regimen success. I tend to agree with him after reading about it’s use and how the CD4 is related to the WBC.
Hi Jane,
Thanks for you question. Although your CD4 count and CD4 percentage are both very good the drugs you are taking are not a recommended combination. It may be that these drugs are working for you but it’s important to talk to your doctor about this. The three drugs in your combination (abacabir, tenofovir and FTC) are all from a drug group called nukes. The recommended HIV treatment is usually two nukes and one drug from a different group (such as protease inhibitors). This is because studies have shown that triple nuke combinations are not good at controlling the viral load. When your viral load is not kept low enough you can develop resistance to treatment.
Do you receive viral load testing? If you do, do you know what your viral load is?
The following reports contain information about triple nuke combinations. It might be useful to show these to your doctor when you discuss this.
Another triple nuke failure: abacavir/ddI/d4T
Tenofovir/abacavir/3TC triple-nuke fails as maintenance regimen
The two nukes…
I am on Abacavir sulfate + truvada for one year now. Analysis of my absolute CD4 count was 646/uL and a CD4 cell % of 29.90% on 8th August 2012. Should I be worried that my CD% is low.