HomeAnswersHIV/AIDS specialisthiv risk factorsKindly clear my doubts regarding the CD4 count.

I am not sick four years after exposure, but my CD4 count is high. Why?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At February 15, 2018
Reviewed AtFebruary 23, 2024

Patient's Query

Hello doctor,

I have a hypothetical question. Suppose I was one of the rare people who is incapable of producing antibodies to HIV (Human Immunodeficiency Virus)-2. What would you expect my CD4 (Cluster of Differentiation) count to be after four years? And how sick would I be?

Answered by Dr. Sushil Kakkar

Hello, Welcome to icliniq.com.

I have noted your concern. Antibodies against HIV are not a very effective defense against this virus and though they may initially contribute in keeping the virus under check they eventually fail to do so. So your CD4 count would be lower than if you had antibodies against HIV and obviously it would imply that there would be a greater risk of opportunistic infections. Regards.

Patient's Query

Hello doctor,

So, I can believe my negative tests? Because I am not sick four years after exposure and I have a high CD4 count, 1100. And if I had HIV-2 with no antibodies after four years I would probably be very sick. Is that correct?

Answered by Dr. Sushil Kakkar

Hello, Welcome back to icliniq.com.

Yes, I believe that is true. I would like to know, when was your last fourth generation HIV (human immunodeficiency virus) screening test after your exposure? What was the nature of exposure? Was it protected or unprotected?

Regards.

Patient's Query

Hello doctor,

My latest fourth generation test was 1.5 years after a brief (less than five seconds) clitoral oral sex exposure with a female. I also had 1 RNA (Ribonucleic acid) HIV-2 test, (negative), 1 proviral DNA (Deoxyribonucleic acid) HIV 2 test, (also negative), and 2 HIV 1 RNA tests (negative) all done 1.5 years post exposure.

Answered by Dr. Sushil Kakkar

Hello, Welcome back to icliniq.com.

A 4th generation HIV screening test is considered conclusive after 12 weeks or three months after a risk exposure by most STD (Sexually Transmitted Diseases) specialists. It tests for both HIV type 1 and 2 antibodies as well as HIV type-1 P24 antigen. So, you need not worry about HIV as that has been convincingly ruled out. Regards.

Patient's Query

Hello doctor,

The synopsis of my concern is as follows: Possible exposure to HIV-2 four years ago. 1.4 years after exposure: a series of six negative 4th generation antibody tests for HIV1 and 2 with p24 antigen test. One year after exposure: two consecutive RNA PCR HIV-1, both negative. 1.5 years after exposure, one HIV-2 RNA by real-time PCR (limit of detections 100 copies per milliliter) was negative. 1.5 years after exposure, one HIV-2 proviral DNA by real-time PCR (limit of detection is about 30 international units per milliliter - so I was told by the diagnostic center in my country) was negative. My questions are: My HIV-2 RNA real-time PCR test would be detectable, reducing the possibility of a false negative (as this often happens for HIV-2 patients with antibodies that suppress messenger RNA replication). My proviral DNA also be detectable (at a lower limit of detection of 30 international units per milliliter) as there would be no antibodies to interfere with the establishment of stable HIV-2 infections. If I was hypothetically infected with HIV-2 (even though it is a slower virus than HIV-1) with no immune response after four years, would you expect that I would be very sick? I am very healthy without so much as a cold in four years.

Answered by Dr. Sushil Kakkar

Hello,

Welcome back to icliniq.com.

The window period of a fourth generation HIV screening test is just two to three weeks; therefore, this test is usually considered conclusive after an intervening period of three to four weeks between risk exposure and the screening test. CDC (Centers for Disease Control and Prevention) states that a fourthth generation HIV screening test takes between 18 to 45 days for it to become positive.

Similarly, the window period of an RNA PCR test and DNA proviral test is short which is, 9 to 13 days, and therefore it is useful as an early test in suspected cases of risk exposure as well as in cases where an antibody-based test is unlikely to be reliable like in infants, agammaglobulinemia, advanced HIV infection, seronegative cases, etc.

Regards.

Patient's Query

Hello doctor,

If I was hypothetically infected with HIV-2 (even though it is a slower virus than HIV-1) with no immune response after four years, would you expect that I would be very sick or even dead?

This will help me get past the worry because I am very healthy without so much as a cold in four years.

Answered by Dr. Sushil Kakkar

Hello,

Welcome back to icliniq.com.

In that case, there is a likelihood that you would have had some signs or symptoms of HIV, like recurrent or opportunistic infections like thrush, bacterial, viral infections, diarrhea, weight loss, etc. However, I would not say that you would have been very sick or dead by now, especially if it is HIV 2. The fact that you are perfectly fine and healthy even after four years of possible exposure goes against HIV infection. Moreover, your laboratory tests for HIV 1 and 2 have not left any doubt about your negative HIV status.

Regards.

Patient's Query

Hello doctor,

Without any antibodies, the situation you described would be even worse. Is that correct? After four years, hypothetically, with no antibodies to HIV-2, would you expect a similar situation?

Answered by Dr. Sushil Kakkar

Hello,

Welcome back to icliniq.com.

Yes, I definitely agree with you on this. Absence of antibody response to HIV is linked to rapid progression to AIDS (acquired immunodeficiency syndrome).

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sushil Kakkar
Dr. Sushil Kakkar

Dermatology

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