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A Review for Clinical Practitioners

Barbara J. Turner, MD, MSEd; Frederick M. Hecht, MD; Rokiah B. Ismail, MBBS, MRCP

Arch Intern Med. 1994;154(14):1561-1573.

Abstract
The CD4⁺ lymphocyte is a major target of the human immunodeficiency virus type 1 (HIV-1). CD4⁺ T-lymphocyte measures have been used to predict the risk of HIV-1— related complications in diverse populations, to guide management decisions, and to define cases of the acquired immunodeficiency syndrome (AIDS). To examine the role of CD4⁺ measures in the management and epidemiologic monitoring of HIV-1 infection, we evaluated current literature regarding the accuracy and precision of CD4⁺ measures and the use of these and other prognostic measures in the care of HIV-1—infected persons. Several studies have reported wide intraindividual and interindividual variability in the absolute CD4⁺ count, which can detract from its clinical usefulness. Approaches to address this variability include the following: drawing specimens at a similar time of the day; monitoring CD4⁺ percent that has less variability; following a meticulous laboratory technique; using serial tests to guide management decisions; and retesting after efforts to eliminate transient treatment and clinical factors that can affect the CD4⁺ count. The expense and limited availability of CD4⁺ measures also present barriers to widespread use. Other laboratory and clinical factors offer additional prognostic information and have an evolving role in management decisions. CD4⁺ measures have an important role in HIV-1 clinical care, research, and disease surveillance, but strategies are required to address problems with variability, expense, and availability.

(Arch Intern Med. 1994;154:1561-1573)

Author Affiliations
From the Division of General Internal Medicine and Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pa (Dr Turner); the Division of General Internal Medicine, San Francisco General Hospital and University of California—San Francisco (Dr Hecht); and the Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur (Dr Ismail).

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