[Question #6397] HIV and Total Lymphocyte

15 months ago
Greetings Doctors, 

I have a question. I’m a 24 year old man. So I have had 8 FINGER PRICK Alere 4th gen tests and 1 Chembio FINGER PRICK SureCheck test over the last 8 months, all negative. My last “risk” (protected sex with a condom that lasted a minute) to which I tested at 6 weeks using a rapid 4th gen FINGER PRICK and at 4.5 months using a rapid 3rd GEN FINGER PRICK. Anyways, I recently did a CBC and WBC Differential. My WBC’s were 4.0 (range 4.0 - 11.0 x 1000mcl) and my Lymphocyte % was 30.3, with the automated count being 1212 (range 1.0 - 3.6 x 1000 mcl) ...I know I am technically in the normal range, but I read that years ago, they would determine if you had AIDS,  if your total lymphocyte count was under 1200. Basically the WHO said your CD4 was most likely under 200 if your total lymphocyte count was under 1200. From what I gather, this can only be applied to individuals already confirmed to have HIV. Even so, it still bothers me..why am in the normal range when they used the result I received to estimate a low CD4? Does this truly only apply to people with confirmed HIV? Is the lab reference range influencing my number? My last HIV test was 6 weeks before I did this CBC and WBC diff and it was negative. My doctor knows my testing history and my no risk sex history for the past 8 months and assures me my labs are normal and I’m HIV negative..but I can’t shake it. My doctor also is begging me to see a psychiatrist. Also, 2 days after the draw for the CBC and WBC Diff, I came down with a head cold, maybe that could explain the low normal WBC? Also when I was 16, my WBC was again, 4.0 x 1000 mcl.. should I be worried if my Lymphocyte count is on the low end of normal and just trust my doctor and be confident in my negative status? 
15 months ago
Just making a quick edit,  the automated Lymphocyte count was 1.2  (range 1.0 - 3.6 x 1000 mcl), the absolute Lymphocyte count was 1212 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Welcome to the forum. Thanks for your confidence in our services.

I'm afraid you're reading old information that is no longer pertinent. In the early AIDS era, HIV tests were far inferior to the ones in use today (including the ones you had) and not widely available. CD4 and lymphocyte counts were used to define probable AIDS. Such testing remains useful in HIV infected persons to evaluate HIV infected persons' immune systems. These tests have no role in evaluating persons at risk for HIV but with negative HIV tests and you should not have had them.

As you state yourself, the numbers you report look pretty normal to me. Even when they don't, these numbers can fluctuate rather widely over the course of a day, and certainly over several weeks, in entirely healthy persons. Beyond that, I have nothing more to say:  this site is limited to issues around HIV and other STDs, and since you have neither, I have no other comments, opinions, or advice about those test results (except to advise you to stop having them.)

As you already know, your test results prove you don't have HIV, and you had a zero risk exposure anyway. The bottom line is that I agree with your doctor and would advise you to follow his advice, including referral for mental health evaluation and care. It is not normal to remain so fearful, or to be unable to "shake" those fears, after such overwhelming evidence and the reasoned, science based reassurance you seem to have had from your doctor. I support his advice out of compassion, not criticism.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
---
---
15 months ago
Thank you Doctor for you insight. I’ve had 9 tests that have all been finger prick, rapid tests at Planned Parenthood, 8 of which have been 4th Gen and the final 3rd Gen test at 4.5 months past any no risk encounter. I’m trying to tackle my OCD and become sexually active and date but, I’ve only been able to kiss a woman and receive oral sex, I can’t bring myself to have sex due to fear. It’s funny, I used to be satisfied with a self administered oral HIV test at 3 months years ago, but my mind has warped and now I’m not even satisfied with 9 finger prick blood tests. Every doctor and clinician has told me to stop and that I’m healthy. I know I could pursue RNA and lab tests but, I can almost promise you, the real problem, OCD, will find something to convince me that those tests could be invalid. I am going to learn to live with .0000001% uncertainties because nothing in life is guaranteed. Thank you Doctor. I really appreciate the you and this forum. If you have any further advice for me, no problem, otherwise you can close this. Hope others who have this issue read this and understand it goes beyond risk and disease but is an issue with being capable of rational thought
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
I have no further advice about HIV risks and testing. However, I do have advice about your obsession with HIV risk and testing, which obviously is worsening and likely having serious impacts on your life -- if nothing else the time to have all those tests over just 4-5 months must have been substantial. I hope you'll consider professional counseling:  out of control OCD can become very disabling. (For an excellent example, see The Aviator, the film biography of the "eccentric" industrialist and Hollywood mogul Howard Hughes -- and as it happens, a great movie with Leonardo DiCaprio and Cate Blanchette.)

Good luck with it. Thanks for the thanks. Best wishes and stay safe.
---