If Someone is HIV+, What Would you Expect From a CBC With and Without Differential?

Question

Thanks Joe T, a HIV+ person On ART?

Labsci, Assuming (Appropriately) that the HIV One would Expect to See an Immediate Drop in the % Lymphocytes Upon Infection (Before Tx), Manifested as a Drop in WBC. After Tx, One Will Probably See a Less of a Drop In % Lymphocytes, and Probably a Mild Drop In WBC. Is this the Case?

Sorry, Labsci, that the HIV is immediately Lytic.

Excuse me Joe T, did I Suggest you Were HIV+? Are you Offended By the Notion?

Thanks Dr. Jon, I Agree With you that the Anemia of Chronic Disease Will Probably Be Normocytic, All I'm Saying, Which I Think Makes Sense, is that Because the CBC is Based On Averages, One Will See Dramatic Differences In HIV Infection Very Early.

Thanks Labsci, but it is Likely to tip the Astute Off.

Answer 1

I have done CBCs on a few HIV+ patients, and have not noticed anything remarkably different. Particularly if they are on treatment. Lymphocytes may be mildly low, but this is not diagnostic. There may be some obvious changes if an infection arises because of the immunodeficiency, but it would depend on the infection. You may see an increase in Monocytes for bacterial, or fungal infection, neutrophils for bacterial, lymphocytes for viral, eosinophils for parasitic infection etc.
I do not work in a specific HIV laboratory, so there may well be a trend of which I am not aware, but I can only speak for the patients I've seen.
If you get septicaemia (blood poisoning), the causative agents may be seen within the white cells while doing the differential. I have seen fungal cells within monocytes and bacteria within neutrophils etc.

An anaemia can develop due to chronic illness (anaemia of chronic disease) due to the continually raised cytokines. These suppress iron metabolism, giving rise to a microcytic, hypochromic anaemia (your red cells are pale and small), and iron deficiency can develop for the same reason. These will be apparent in the CBC as a low Haemoglobin and low mean red cell volume (MCV).

Edit: I agree that ACD may present as normocytic, but it does progress to microcytic if condition is not managed. Generally, by the time the chronic condition is recognised, the iron metabolism has been affected, and it is seen as microcytic hypochromic, in my experience.
The presenting conditions for HIV are not specific, and you would be a brave person to suggest HIV from the CBC. Initial presentation is, I believe, similar to a mild viral illness, with some lymphocytic involvement (?Atypicals), a few months after infection, followed by variable latency, sometimes of years. But again it is not my area of expertise.

Answer 2

Just a point of clarification. Anemia of chronic disease can present as either normocytic or microcytic anemia. But, overall, like labsci mentioned, the CBC with diff is normal, overall. With different features at different times.

Examples include pancytopenia at advanced stages due to marrow involvement of HIV or secondary infective agents. The ratio between CD4/CD8 obviously gets out of whack. They also present at various times with a true monocytosis, though this is a non-specific finding.

Answer 3

The initial CBC is to establish a baseline as to the current state of the cells that make up your blood. Testing thereafter is used to detect changes in your HIV status and alert the doctor that something needs to be done differently to treat the disease.

No...I'm not HIV+...just a virologist.