Content Map Terms

CD4+ Count

Test Overview

A CD4+ count is a blood test to determine how well the immune system is working in people who have been diagnosed with human immunodeficiency virus (HIV). CD4+ cells are a type of white blood cell. White blood cells are important in fighting infections. CD4+ cells are also called T-lymphocytes, T-cells, or T-helper cells.

HIV infects CD4+ cells. The number of CD4+ cells helps determine whether other infections (opportunistic infections) may occur. The pattern of CD4+ counts over time is more important than any single CD4+ value because the values can change from day to day. The CD4+ pattern over time shows the effect of the virus on the immune system. In people infected with HIV who are not getting treated, CD4+ counts generally decrease as HIV progresses. A low CD4+ count usually indicates a weakened immune system and a higher chance of getting opportunistic infections.

Why It Is Done

CD4+ counts are done to:

  • Monitor how the HIV infection is affecting your immune system.
  • Help diagnose acquired immune deficiency syndrome (AIDS). HIV infection can progress to AIDS, which cannot be cured.
  • Evaluate your risk for other infections (opportunistic infections).
  • Decide when to start treatment to prevent opportunistic infections, such as medicines to prevent Pneumocystis pneumonia.

A CD4+ cell count taken at the time you are diagnosed serves as the baseline against which future CD4+ cell counts will be compared. Your CD4+ cell count is monitored every 3 to 6 months, depending on your health status, previous CD4+ cell counts, and whether you are taking antiretroviral therapy medicines.

How To Prepare

Before you have this test, you may have the opportunity to meet with a counsellor so that you understand what the test results could mean about your HIV infection.

How It Is Done

The health professional drawing blood will:

  • Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
  • Clean the needle site with alcohol.
  • Put the needle into the vein. More than one needle stick may be needed.
  • Attach a tube to the needle to fill it with blood.
  • Remove the band from your arm when enough blood is collected.
  • Apply a gauze pad or cotton ball over the needle site as the needle is removed.
  • Apply pressure to the site and then a bandage.

How It Feels

You may feel nothing at all from the needle puncture, or you may feel a brief sting or pinch as the needle goes through the skin. Some people feel a stinging pain while the needle is in the vein. But many people do not feel any pain (or have only minor discomfort) after the needle is positioned in the vein. The amount of pain you feel depends on the skill of the health professional drawing the blood, the condition of your veins, and your sensitivity to pain.

Risks

There is very little risk of complications from having blood drawn from a vein.

  • You may develop a small bruise at the puncture site. You can reduce the risk of bruising by keeping pressure on the site for several minutes after the needle is withdrawn.
  • In rare cases, the vein may become inflamed after the blood sample is taken. This condition is called phlebitis and is usually treated with a warm compress applied several times daily.

Results

A CD4+ count is a blood test to determine how well the immune system is working in people who have been diagnosed with human immunodeficiency virus (HIV). CD4+ cell count results are generally available in 1 to 3 days, depending on the lab.

The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what's normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Total CD4+ count

Normal:

CD4+ cell counts in people who are not infected with HIV usually range from 600 to 1,500 cells per microlitre (mcL). footnote 1

Abnormal:

A CD4+ cell count greater than 350 but less than 500 cells/mcL means that the immune system is beginning to weaken.

A CD4+ cell count of fewer than 350 cells/mcL indicates a weak immune system and an increased risk for opportunistic infections.

A CD4+ cell count of fewer than 200 cells/mcL indicates acquired immunodeficiency syndrome (AIDS) and a high risk for opportunistic infections.

As the CD4+ count drops, it becomes more likely that acquired immunodeficiency syndrome (AIDS) will develop.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

  • The time of day when the CD4+ is measured. CD4+ counts may be lower in the morning.
  • Illnesses, such as pneumonia, herpes simplex infection, or influenza.
  • Refrigeration of the blood sample.
  • Medicines, such as corticosteroids and chemotherapy medicines.

What To Think About

  • The pattern of CD4+ counts over time is more important than any single CD4+ value. CD4+ counts typically decrease as HIV progresses.
  • The CD4+ cell count is often done with viral load testing to measure the effectiveness of antiretroviral therapy. The viral load test measures the actual amount of HIV in the blood, which is a good indicator of how well medicines are controlling the HIV infection. In some cases, viral load testing may be done instead of the CD4+ count. To learn more, see the topic Viral Load Measurement.
  • The Canadian AIDS Treatment Information Exchange (CATIE) recommends that, if possible, people begin antiretroviral therapy (ART) for HIV before their CD4+ count falls below 350 cells/mcL. Treatment is especially important for pregnant women, people who have other infections (such as tuberculosis or hepatitis), and people who have symptoms of AIDS.footnote 2 Talk to your doctor about when you should start ART.
  • Because total CD4+ count can vary throughout the day, many doctors also monitor the number of CD4+ cells in relation to the total number of lymphocytes. This measurement is called the CD4+ percentage.
  • Another measurement that may be used is the CD4 count (T helper cells) in comparison with the CD8 count (T suppressor cells). This is called the CD4/CD8 ratio. All of these measurements can help determine the effectiveness of HIV treatment.
  • Testing for HIV infection is a different test. To learn more, see the topic Human Immunodeficiency Virus (HIV) Test.

References

Citations

  1. Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
  2. Canadian AIDS Treatment Information Exchange (2011). A Practical Guide to HIV Drug Treatment for People Living with HIV. 3.4, When to Start. Available online: http://www.catie.ca/en/practical-guides/practical-guide-hiv-drug-treatment-people-living-hiv/3-treating-hiv/34-when-start.

Other Works Consulted

  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
  • U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2013). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.

Credits

Current as of:
July 1, 2021

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Peter Shalit MD, PhD - Internal Medicine