What opportunistic infections are associated with a CD4 (Cluster of Differentiation 4) count of 285 cells per cubic millimeter?

From the Guidelines

A CD4 count of 285 cells per cubic millimeter is generally not associated with major opportunistic infections, but patients may have an increased risk of certain infections such as bacterial pneumonia, tuberculosis reactivation, candidiasis, and herpes zoster. At this level, the immune system is mildly compromised but still provides significant protection against most opportunistic pathogens. Typically, serious opportunistic infections become more common when CD4 counts fall below 200 cells/mm³ 1. However, patients with a CD4 count of 285 cells/mm³ may have an increased risk of certain infections compared to those with normal CD4 counts (500-1500 cells/mm³). These include:

• Bacterial pneumonia
• Tuberculosis reactivation
• Candidiasis (particularly oral thrush)
• Herpes zoster (shingles) Patients with this CD4 level should receive prophylaxis against Pneumocystis jirovecii pneumonia if they have additional risk factors such as oral thrush or unexplained fever 1. The mild immunosuppression at this CD4 level reflects a gradual decline in immune function, where the body maintains defense against most common pathogens but begins to show vulnerability to certain infections that take advantage of the slightly weakened immune response. Regular monitoring of CD4 counts is important to track immune function and adjust preventive strategies as needed 1.

From the Research

Opportunistic Infections at CD4 Count of 285

At a CD4 count of 285 cells per cubic millimeter, the risk of opportunistic infections is lower compared to those with CD4 counts below 200 cells/mm³. However, some infections can still occur:

• Tuberculosis (TB) 2
• Oral candidiasis 2, 3
• Diarrhea 2
• Other respiratory infections 3

CD4 Count and Opportunistic Infections

Studies have shown that the risk of opportunistic infections increases as the CD4 count decreases:

• CD4 count less than 200 cells/mm³ is associated with a higher risk of opportunistic infections 4, 2, 3
• CD4 count below 350 cells/mm³ is considered a threshold for initiating antiretroviral therapy (ART) to prevent opportunistic infections 2

Specific Infections and CD4 Counts

Some opportunistic infections are associated with specific CD4 count ranges:

• Pneumocystis carinii pneumonia (PCP) typically occurs at CD4 counts below 200 cells/mm³ 4, 3
• Toxoplasmic encephalitis can be prevented with trimethoprim-sulfamethoxazole prophylaxis, which is recommended at CD4 counts below 200 cells/mm³ 4
• Mycobacterium avium complex (MAC) infection typically occurs at CD4 counts below 50 cells/mm³ 4, 5

HIV RNA Levels and Opportunistic Infections

HIV RNA levels can also be associated with the risk of opportunistic infections:

• Different opportunistic infections are associated with different HIV RNA levels, regardless of CD4 count or antiretroviral therapy (ART) 5
• Kaposi sarcoma, esophageal candidiasis, oropharyngeal candidiasis, and Mycobacterium avium complex disease are associated with higher HIV RNA levels 5