Disclaimer: The views and opinions expressed in this piece are the author’s and do not necessarily represent the position of Positive Women’s Network – USA.
February 10, 2020
by: Connie Shearer
According to i-base.info, the immune system contains a lot of different cells. The two main types of lymphocytes are T cells and B cells. CD4 cells are a type of T cell. So, the CD4% looks at the CD4 count in relation to other immune cells.
Sometimes, a CD4% is a more stable indication of whether there has been a change in the immune system versus an Absolute CD4. Because CD4 counts fluctuate during the day, not just when we are sick or stressed. They are lower in the morning, higher later in the day or directly after exercise.
An unexpected drop in CD4 count when the percentage hasn’t changed indicates the drop to not be clinically significant. So, knowing that would lead us to the conclusion that even if there is a blip on one’s viral load, but an increase in the percentage of the blip would also not be clinically significant to our overall health. I believe that, and I also believe that the focus of our doctors and HIV peers should be on this percentage and getting it and keeping it as high as possible.
I wanted to write about CD4 % because not many people are sharing this information even though the science around it is solid. I feel this should be a conversation being shared with Long-Term Survivors as well as newly diagnosed people. Being informed early in their diagnosis just how equally important overall healthcare, combined with adherence, TASP, U=U, PrEP, housing and continued access to care are may encourage others to take their healthcare more seriously.
I became aware of my CD4% for the first time at an appointment with Dr. Warren Magnus at AHF in Las Vegas. He explained it to me for the first time about 2 years ago, and I thought it was something everyone knew about and was incorporating into their discussions about overall care. It wasn’t. I attended a dinner and learn sponsored by ViiV Healthcare that gave me some great information, and I’m thankful. I plan to switch as soon as I have the option to switch.
And not just because Alphonso (their model on this link walked me across the stage at Sisterlove’s Leading Women Society when I was inducted in 2018. I have heard some good things and would like to make the switch.
However, the speaker at our dinner and learn kept talking about the importance of getting to undetectable and maintaining viral suppression. But he never mentioned that it was important because doing so would increase your CD4 % thus increasing your overall health. When I asked about this, he couldn’t discuss percentages because he was only trained to talk about being undetectable.
Being undetectable isn’t an option for everyone. But, speaking from personal experience of seeing my CD4 % rise from 35% to 42.1 %, this is a conversation we need to be having. I will be living with HIV for 25 years on February the 20th. I have adherence issues and housing insecurity, and I struggle to maintain my care for personal reasons. I was still able to raise my percentage up 7 points in less than two years because of my access to treatment.
Here’s a few bullet points from i-base.info:
- A CD4 % of 12 – 15 % is about the same as a count of under 200 cells/mm
- A CD4 % of 29% is about the same as a count of over 500 cells/mm, but there is a wider range for higher values.
- The average normal CD4 percentage for someone who is HIV negative is about 40%. The normal range is anywhere from about 25% to 65%.
I am not trying to take away from the life-changing message of U=U, but the science is solid with this information too. Raising your CD4% should be way more important of a conversation we should be having with our infection disease doctors than our viral load or undetectable status, at least in relation to our overall health.