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 causes AIDS, a long-term chronic disease that cannot be cured.
• Decide when to start antiretroviral therapy, which slows the rate that HIV grows in the body. See the Results section for more information.
• Evaluate your risk for developing other infections (opportunistic infections).
• Decide when to start treatment to prevent opportunistic infections, such as medicines to prevent Pneumocystis carinii pneumonia (PCP).

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 highly active antiretroviral therapy (HAART) medications.

How To Prepare

Before you have this test, you may have the opportunity to meet with a counselor 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. However, many people do not feel any pain (or have only minor discomfort) once 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.