Diagnosing HIV-Related disease

Using the CD4 count as a guide
  • Alan C. Jung
  • Douglas S. Paauw
Clinical Review


OBJECTIVE: To summarize current information on the relation between CD4 counts and the risk of different HIV-related diseases.

MEASUREMENTS AND MAIN RESULTS: MEDLINE search of English language articles between 1985 and 1996 using the medical subject heading (MeSH) term “CD4 lymphocyte count” and searches using key words of multiple HIV-related diseases were conducted. Some HIV-related diseases can be stratified to different CD4 count levels. Regardless of their CD4 count, HIV-infected patients are susceptible to sinusitis, Kaposi’s sarcoma, community-acquired pneumonia, and oral hairy leukoplakia. In advanced HIV, when CD4 is below 200/mm3, Pneumocystis carinii pneumonia, toxoplasmosis, progressive multifocal leukoencephalopathy, Mycobacterium avium complex, molluscum contagiosum, and bacillary angiomatosis all increase in incidence. In very advanced HIV disease, when CD4 counts are below 50/mm3, patients are at risk of pseudomonas pneumonia, cytomegalovirus retinitis, central nervous system lymphoma, aspergillosis, and disseminated histoplasmosis.


Regardless of their CD4 count, HIV-infected patients are susceptible to sinusitis, community-acquired pneumonia, oral hairy leukoplakia, Kaposi’s sarcoma, and HIV meningitis. Once their CD4 counts drop below 500/mm3, they are at risk of developing tuberculosis, thrush, herpes simplex, and herpes zoster. In advanced HIV, when their CD4 counts are below 200/mm3, PCP, coccidioidomycosis, bacillary angiomatosis, molluscum contagiosum, cryptococcal meningitis, toxoplasmosis, progressive multifocal leukoencephalopathy, Mycobacterium avium complex, and non-Hodgkin’s lymphoma all increase in incidence. In very advanced HIV, when their CD4 counts are below 50/mm3, they are at risk of pseudomonas pneumonia, CMV retinitis, CNS lymphoma, aspergillosis, and histoplasmosis. By appreciating these characteristic changes in disease incidence, and by knowing a patient’s CD4 count, clinicians should be better able to develop differential diagnoses and plans for diagnostic evaluation.

Key words

CD4 count HIV-related disease risk stratification 


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Copyright information

© Society of General Internal Medicine 1998

Authors and Affiliations

  • Alan C. Jung
  • Douglas S. Paauw
    • 1
  1. 1.Department of Medicine, Box 356420, Division of General Internal MedicineUniversity of WashingtonSeattle

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