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Low CD4 Count Question
Hi Dr. HHH/Hook,
I'll try to be as brief as possible but would appreciate your opinions.
Young, fit, normally healthy late 20s male.
Suffered from recurring chest/sinus infections at the end of 2013 and also twice in January 2014. Latest one resolved eventually with antibiotics. Otherwise in good health and saw a doctor to see what was wrong with me. Dr. ran a number of blood tests and expressed concern to me about HIV because my CD4 (taken while I was sick) count was 376 (below 400 which is the minimum 'norm'), with CD8 at 542 - a ratio of 0.7. WBC was 11.7, slightly abnormally high.
I had a NAAT/PCR and also rapid antibody test done in December 2013 - both negative. When they Dr. expressed concern about HIV - I was obviously alarmed and had a rapid antibody test done that day - negative.
I am concerned because in late December I had an encounter with 2 guys at the same time, protected insertive anal sex by me except for probably a minute or so at most of unprotected insertive anal.
Timing for the CBC/WBC/CD4 blood work was 30 days post possible exposure and the negative antibody test was 39 days post possible exposure.
Questions are:
What is your risk assessment of my situation?
Is it likely that the low CD4 count could be caused by HIV/ARS or with bronchitis/sinus infection?
Is a higher WBC normally associated with HIV/ARS?
In this situation, does the 39 day antibody test offer much comfort?
I am going to get the CBC and CD4 blood work repeated in a week, if my CD4 count is at a normal level, should there be much cause for concern?
Thanks in advance.
I'll try to be as brief as possible but would appreciate your opinions.
Young, fit, normally healthy late 20s male.
Suffered from recurring chest/sinus infections at the end of 2013 and also twice in January 2014. Latest one resolved eventually with antibiotics. Otherwise in good health and saw a doctor to see what was wrong with me. Dr. ran a number of blood tests and expressed concern to me about HIV because my CD4 (taken while I was sick) count was 376 (below 400 which is the minimum 'norm'), with CD8 at 542 - a ratio of 0.7. WBC was 11.7, slightly abnormally high.
I had a NAAT/PCR and also rapid antibody test done in December 2013 - both negative. When they Dr. expressed concern about HIV - I was obviously alarmed and had a rapid antibody test done that day - negative.
I am concerned because in late December I had an encounter with 2 guys at the same time, protected insertive anal sex by me except for probably a minute or so at most of unprotected insertive anal.
Timing for the CBC/WBC/CD4 blood work was 30 days post possible exposure and the negative antibody test was 39 days post possible exposure.
Questions are:
What is your risk assessment of my situation?
Is it likely that the low CD4 count could be caused by HIV/ARS or with bronchitis/sinus infection?
Is a higher WBC normally associated with HIV/ARS?
In this situation, does the 39 day antibody test offer much comfort?
I am going to get the CBC and CD4 blood work repeated in a week, if my CD4 count is at a normal level, should there be much cause for concern?
Thanks in advance.
MEDICAL PROFESSIONAL
1) What I have generally written about the window for the modern antibody tests is 6-8 weeks. Six weeks probably is plenty -- and 39 days is close enough. The available data aren't all that precise, but the bottom line is that nobody has ever been documented to have a negative 3rd gen antibody test at that time who later turned out to have HIV. If you want to call it say 99.9% reliable and then split hairs about that figure versus 100%, feel free to do so. But straight-thinking people don't do that.
2) Yes.
3) Of course I factored in that risk. But because of your test result, I'm not at all concerned about it.
You came here for reassurance. I gave it, repeatedly, with scientific explantions of my rationale. But you keep arguing, as if you're looking for confirmation that you're about to die of HIV! Accept the reassurance or not, I don't care -- but this isn't a debate. There will be no further discussion; continuing argumentative comments that ignore my advice will result in immediate deletion of the entire thread.
2) Yes.
3) Of course I factored in that risk. But because of your test result, I'm not at all concerned about it.
You came here for reassurance. I gave it, repeatedly, with scientific explantions of my rationale. But you keep arguing, as if you're looking for confirmation that you're about to die of HIV! Accept the reassurance or not, I don't care -- but this isn't a debate. There will be no further discussion; continuing argumentative comments that ignore my advice will result in immediate deletion of the entire thread.
Dr. HHH, thank you for your time so far - I am reassured by your comments. For my own knowledge going forward, and for anyone viewing this thread, could you please clarify the following questions? This will be my last comment if you could elaborate on each of the below.
1. From the above, I gather that you are stating that my negative antibody test 39 post exposure would be conclusive. The negative antibody test was performed approximately 5.5 weeks post any possible exposure, and in other threads you now state that 8 weeks is conclusive. Could you comment on this, as the NAAT/PCR was only a baseline last year, and has no bearing on the exposure that happened after it was performed.
2. As with the above question, are you also taking into account my CD4/CD8 levels in your assessment, and if there was HIV involved, how would these levels, along with my other CBC results differ from what I have presented?
3. As above, are you factoring in the risk I had with the 2 guys, and if so, what makes you not so concerned about it?
Thank you again.
1. From the above, I gather that you are stating that my negative antibody test 39 post exposure would be conclusive. The negative antibody test was performed approximately 5.5 weeks post any possible exposure, and in other threads you now state that 8 weeks is conclusive. Could you comment on this, as the NAAT/PCR was only a baseline last year, and has no bearing on the exposure that happened after it was performed.
2. As with the above question, are you also taking into account my CD4/CD8 levels in your assessment, and if there was HIV involved, how would these levels, along with my other CBC results differ from what I have presented?
3. As above, are you factoring in the risk I had with the 2 guys, and if so, what makes you not so concerned about it?
Thank you again.
MEDICAL PROFESSIONAL
None of this changes my opinioin or advice. Your slighty low CD4 count doesn't concern me at all and should not concer you. Your HIV test results prove you don't have it. Do your best to stop worrying about it.
Doctor - thank you - but this means you are saying that a 39 day post exposure antibody ONLY test is conclusive? The NAAT is not relevant to the exposure as it was performed before the exposure.
IGG/IGA/IGM were all in normal reference range, however. Will wait for your response now.
Doctor, an additional comment/question. The bloodwork included IGG sublclass tests and all were in a normal reference range except for IGG Subclass 3 which was 16 with a normal reference range of 21-134.
Would having this kind of deficiency extend the window period of HIV antibody tests or affect the test in any other way?
Would having this kind of deficiency extend the window period of HIV antibody tests or affect the test in any other way?
Doctor,
Thank you for such a quick response.
I think I was a little unclear in my original post so I will clarify the timeline:
Baseline Negative NAAT/Antibody Test: Early December
Possible Exposure: 26th December
Bronchitis/Sinus Infection: ~10th January
CBC with Diff/Bloodwork: 24th January (30 days post possible exposure)
Clearview Complete Rapid HIV1/2 Negative Antibody Test: 3rd February (39 days post possible exposure)
So to clarify, the only current negative indication I have is the antibody test at 39 days. Would you mind please commenting on this plus the CBC/CD4 at 30 days? In your opinion, does my bloodwork as a whole indicate anything to do with HIV?
More details of the CBC follow:
WBC 11.7
POLYS/NEUTROPHILS 82%
POLYS # 9.6K
LYMPH 8%
LYMPH # 0.9
MONO 9%
EOS 1%
CD4 29%
CD4 # 376
CD8 41%
CD8 # 542
Thank you again.
Thank you for such a quick response.
I think I was a little unclear in my original post so I will clarify the timeline:
Baseline Negative NAAT/Antibody Test: Early December
Possible Exposure: 26th December
Bronchitis/Sinus Infection: ~10th January
CBC with Diff/Bloodwork: 24th January (30 days post possible exposure)
Clearview Complete Rapid HIV1/2 Negative Antibody Test: 3rd February (39 days post possible exposure)
So to clarify, the only current negative indication I have is the antibody test at 39 days. Would you mind please commenting on this plus the CBC/CD4 at 30 days? In your opinion, does my bloodwork as a whole indicate anything to do with HIV?
More details of the CBC follow:
WBC 11.7
POLYS/NEUTROPHILS 82%
POLYS # 9.6K
LYMPH 8%
LYMPH # 0.9
MONO 9%
EOS 1%
CD4 29%
CD4 # 376
CD8 41%
CD8 # 542
Thank you again.
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
The bottom line is good news: you can be certain you don't have HIV.
The HIV blood tests (the HIV tests themselves, not CD4 etc) are among the most accurate diagnostic tests ever developed, for any medical condition. As such, as long as testing is done sufficiently long after the last possible exposure, the results outweigh all other considerations in determining whether or not someone has HIV: exposure history, symptoms, CD4 count, or anything else you can think of. The combination of negative HIV NAAT and antibody at 5+ weeks after exposure (39 days) is conclusive.
I'm puzzled why your doctor did a lymphocyte subset analysis (CD4, CD8) in the first place. In the absence of a diagnosed HIV infection, such testing normally has little accepted role in diagnosis of pneumonia, bronchitis, or other respiratory infections. Almost any virus, including those that are common causes of symptoms like yours, can temporarily lower CD4 and raise CD8 lymphocytes.
My only other advice is that if and when you have future sexual experiences with other men, don't cut corners on condoms for anal sex. Even brief or transient unprotected anal sex is unacceptable from a sexual safety standpoint. You clearly did not acquire HIV this time, but your future risk could be high with similar exposures. You also should be discussing HIV status with your partners before having sex; don't have anal at all, even with a condom, with men who are HIV positive (and not on effective treatment with low viral loads), don't know, or seem evasive about it.
Anyway, for now you have no worries about HIV. I'm not certain it's necessary to repeat CD4/CD8 testing. I suppose you'll want to do it and be assured they are returning to normal -- but discuss it with your doctor.
I hope this has been helpful. Best wishes-- HHH, MD
The bottom line is good news: you can be certain you don't have HIV.
The HIV blood tests (the HIV tests themselves, not CD4 etc) are among the most accurate diagnostic tests ever developed, for any medical condition. As such, as long as testing is done sufficiently long after the last possible exposure, the results outweigh all other considerations in determining whether or not someone has HIV: exposure history, symptoms, CD4 count, or anything else you can think of. The combination of negative HIV NAAT and antibody at 5+ weeks after exposure (39 days) is conclusive.
I'm puzzled why your doctor did a lymphocyte subset analysis (CD4, CD8) in the first place. In the absence of a diagnosed HIV infection, such testing normally has little accepted role in diagnosis of pneumonia, bronchitis, or other respiratory infections. Almost any virus, including those that are common causes of symptoms like yours, can temporarily lower CD4 and raise CD8 lymphocytes.
My only other advice is that if and when you have future sexual experiences with other men, don't cut corners on condoms for anal sex. Even brief or transient unprotected anal sex is unacceptable from a sexual safety standpoint. You clearly did not acquire HIV this time, but your future risk could be high with similar exposures. You also should be discussing HIV status with your partners before having sex; don't have anal at all, even with a condom, with men who are HIV positive (and not on effective treatment with low viral loads), don't know, or seem evasive about it.
Anyway, for now you have no worries about HIV. I'm not certain it's necessary to repeat CD4/CD8 testing. I suppose you'll want to do it and be assured they are returning to normal -- but discuss it with your doctor.
I hope this has been helpful. Best wishes-- HHH, MD
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