Question
How do I know when to take treatment with a fluctuating CD4 count?
26 March 2010. Related: All topics, CD4 and viral load.
My CD4 count seems to fluctuate considerably each time I have it checked. I have agreed with my consultant to start medication which it gets to about 450. How will I know when it gets there as no two consecutive results seem to be the same or near the same?
Answer
Thank you for your question.
CD4 fluctuations are common. CD4 count results can depend on many things such as the time of day a test is done, exercise, menstrual cycle, stress, how much sleep you had, other underlying infections, vaccinations and lab mistakes. If you are worried and this is occurring regularly it may be worth talking to your doctor about having multiple tests done at one time to ensure it is not a lab error.
Only a small proportion of CD4 cells are found in the blood, the rest are found in either your lymph nodes or tissues. The CD4 cells travel between the blood, the lymph nodes and tissues. This movement of CD4 cells in and out of the blood could also cause fluctuations in your test results.
Your CD4% tends to be more stable than the absolute CD4 count. You should ask your doctor for your CD4% to see if these results show fewer fluctuations. This may help you decide when to start medication.
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Hi Thoban,
Once you start HIV treatment (ART) your viral load goes down very quickly. This mean your CD4 count can recover, but usually this is slower than the decrease in viral load. Here are pictures showing what happens to HIV and CD4 after starting ART.
6 months ago I was diagnosed with HIV, my cd4 count was 5, av been on treatment since then. Just want to know if my Cd4 count has increased just an estimation because they took my blood at the clinic and gave me a returning date but am very curious pls help with an estimation of how much cld my cd4 increased to
Hi Darlington, when CD4 counts are above 500, this sort of change is unlikely to be a real change. It is either a normal fluctuation or just something that can happen with the test. Your next test is very likely be higher again.
I have a case of sudden cd4 drop from 995 to 716 after 6mnths interval of lab test am kinda worried, what could be the cause?
Hi John
The CD4 drop does seems unusual – but this might mean that it is a lab error of a mix up with the resutls. In the UK the doctor would take another CD4 test to check, rather than leaving this for 3 months. You coudl ask your doctor is your CD4% changed. If yes, then the drop might be real, but if not, then this is unlikley to be important. With adherence, there is enough flexibility for 30 minutes either way – or even an hour or two – to be fine.
Pls I so much appreciate your response to question, I started taking this all in one AVR drugs , only in the night and when I started taking it after three months my cd4 increase from 421 to 482 and I was very happy but this month as I went to do my cd4 test the thing drop drastically from 482 to 198 after just 3 months and have been healthy than before . Pls am so confused bcoz my doctor said I should not worry and that I should do the test in 3 months time and he also place me on selenium drug. Pls what is the cause? I still want to ask that, if am 30 mins late in taking my drugs will that also affect my cd4 count and make me resistance to the drugs. thanks
Thanks again for this.
Final question on this topic, what is the CD4% equivalent of the recommended starting point for treatment CD4 350?
Thank you for your question.
A CD4 count of 500 is roughly equivalent to a CD4% of 29%.
Thank you for this answer and thank you for this service, it is invaluable!
My first CD4% was 27% and the second was 30%. If I use my CD4% as a guide to starting treatment and wanted to start at the equivalent of a CD4 count of 500 what would my CD4% have to be?