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 Tim, thanks, your doctor is giving you good general advice. This is because once you are on treatment, having an undetectable viral load is more important than the CD4 count.
Although it must feel frustrating, maybe you just have a naturally low CD4 count. Some people who do not have HIV have a normal CD4 count that is lower than 350 and this might just be your the case for you. Most people never know what their CD4 count was before they became HIV positive.
Do you know your CD4:CD8 ratio pr your CD4%. These might easily be in the normal range.