Is 380 a Good Number?

Posted by Pozziepinoy on 8:31 AM

Hi Readers,

Thank you for reading this blog and thank you Pozzie Pinoy for asking me to make a contribution surrounding the question of CD4 numbers, what they might mean, and what defines a good one.



HIV+ people, especially those who are newly diagnosed, have to start dealing with a various numbers that possibly indicate things they may have never even heard of before.  The one of the greatest concern to most HIV+ people is their CD4 count.  

Q.  What is a CD4 cell?  
A.  CD4 cells are a vital part of the immune system.  They lead the attack against infection by producing antibodies that inactivate harmful substances.  These cells are targeted by HIV and killed by it.  Thus the level of CD4 cells in the blood is a leading indicating indicator of the health of a persons immune system.  

There are essentially 2 "numbers" used when measuring CD4 levels.  (1) The number of cells per microliter (uL) of blood.  (2) The percentage of lymphocytes (small white blood cells) that are CD4 cells.

(1)  Normal counts using this system are usually considered to be between 500 and 1600.  HIV infections are classified based on CD4 count and clinical symptoms.  The United States Centre for Disease Control uses the following classification system. 

Stage 1: CD4 count ≥ 500 cells/uL and no AIDS defining conditions.
Stage 2: CD4 count 200 to 500 cells/uL and no AIDS defining conditions.  An HIV+  person with a CD4 of 380 and no AIDS defining conditions.
Stage 3: CD4 count ≤ 200 cells/uL or AIDS defining conditions.  An HIV+ person with a CD4 of 380 and AIDS defining conditions would fit here.

Note.  If AIDS defining conditions are present at any CD4 count then the patient is diagnosed as having AIDS.

AIDS defining conditions are those ones present in HIV+ people that are considered serious opportunistic infections and illnesses.

(2)  However, because the CD4 cell counts are so variable, some health care providers prefer to look at the CD4 cell percentages.  Normal percentages using this system very depending on the laboratory doing the testing.  Different labs use different ranges usually somewhere between 26% and 60%.  There are no guidelines for treatment decisions based on CD4%.  However, a CD4% below 14% is considered to be a definition of AIDS.

Note.  If AIDS defining conditions are present at any CD4 cell percentage then the patient is diagnosed as having AIDS.

The decision regarding the commencement of ARV (Anti Retro Viral) Therapy is obviously influenced by the CD4 count &/or CD4% when the latter is AIDS defining.  The guidelines relating to the CD4 count very from country to country. It depends primarily if that country is a recipient of ARV provided by the Global Fund or not.  

In the Philippines, like other countries whose ARV is provided free by the Global Fund, it is recommended that ARV be initiated when a persons CD4 count falls below 350.  In wealthier countries it is usually initiated when the CD4 count falls below 500.  It is always initiated when a HIV+ person has an AIDS defining condition unless that condition requires treatment the precludes the use of ARV due to drug interactions etc.

Q.  So what is a "good" number?  Is 380 a "good" number?
A.  There is no one "good" number.  As stated previously, AIDS defined primarily by the condition, if any, that is present even if the CD4 number is above 200 or the CD4 cell% is above 14%.  Thus while 380 is not AIDS defining, it isn't in the normal range and doesn't preclude an AIDS diagnosis.  However, it is not, on it's own, AIDS defining.  Obviously the better numbers are those that lie within the normal range.  AIDS defining conditions are far less likely to occur within the normal range.  

I hope readers have found this post helpful and thought provoking.  

Credits.  1) The United States Centre for Disease Control.
               2) The Thai Red Cross AIDS Research Centre.


Stay healthy and compliant with your ARV regimen,

Malcolm Brown
International Contributor




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