Question

Are these results contradictory?

22 August 2008. Related: All topics, CD4 and viral load.

My base line CD4 was 273, CD4%-14%, VL= 8660.
This seems a bit of a contradiction to me. The low CD4 count, the VL should be much higher (according to what I read).

Answer

Answer: Simon Collins

In fact, sometimes there are results like that and they are called discordant results. Genrally speaking, data show that the annual CD4 decline correlates to the VL only on population level and personal fluctuations are quite large.

Factors that influence the CD4 count are:

• Seasonal and diurnal variation (lowest at 12:30 PM, highest at 8:30 PM), surgery, viral infections, tuberculosis.
• Decreases with some medications (e.g. corticosteroids, especially with acute use, less pronounced with chronic use; PEG-IFN, IFN; cancer chemotherapy).
• Acute changes in CD4 more often due to redistribution of CD4 in lympathics, spleen and bone marrow.
• Splenectomy causes abrupt, prolonged increase in CD4. In asplenic pts, CD4% is more accurate assessment of immune status
• HTLV-I can increase CD4 (may have low CD4% with disproportionately high CD4 count). HTLV-I common in Brazil, Caribbean, & Japan.
• Sex, race, psychologic stress, & physical stress have minimal effect on CD4. Pregnancy leads to hemodilution & a small decline in CD4 count, but no decline in CD4%.

What is important for you, however, is that if you have a confirmed result and your readings are in the same zone, then it is a good idea to start discussing a possible initiation of therapy with your doctor.