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Pattern of infection in HIV and different CD4 counts

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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pattern of infection in HIV and different CD4 counts

The CD4 count is an indicator of the degree of immunosuppression in those infected with HIV.

  • in healthy individuals the CD4 count is usually above 500 cells/µl (some may have naturally lower counts)
  • in untreated HIV patients, the average rate of CD4 count decreases between 40-80 cells/µl per year (some may progress faster than others)
    • a more rapid decline is likely to be present in patients who are not taking antiretroviral treatment and who have a high viral load
  • patients with a CD4 count below 200 cells/µl are at most risk of HIV related problems (1)

Even at low CD4+ve lymphocyte levels, the T lymphocytes that remain still afford some protection against infection. This is manifest in a hierarchy of opportunistic pathogens, which begin to occur as the CD4+ve cell count declines.

CD4 counts and HIV related problems:


CD4 count cells/µl

risk of opportunistic infection

risk of HIV-associated
tumours

direct HIV
effects

500 and below

little risk

  • Hodgkin's disease
  • cervical cancer

 

400 and below

  • bacterial skin infections
  • recurrent bacterial skin infections
  • tuberculosis
  • oropharyngeal candida
  • fungal infections (skin, feet, nails)
  • seborrhoeic dermatitis

 

  • lymphadenopathy
  • sweats

350 and below

  • oral hairy leukoplakia
  • shingles
  • Pneumocystis pneumonia
  • persistent herpes simplex infections
  • non Hodgkin "s lymphoma
  • weight loss

200 and below

  • oesophageal candida
  • histoplasmosis
  • cryptococcal meningitis
  • cerebral toxoplasmosis
  • cryptosporidiosis
  • Kaposi "s sarcoma
  • diarrhoea
  • wasting

100 and below

  • Cytomegalovirus infections
  • Mycobacterium avium intracelleulare
  • primary cerebral lymphoma
  • dementia

Reference:

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