CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection

Ann Intern Med. 1989 Aug 1;111(3):223-31. doi: 10.7326/0003-4819-111-3-223.


Study objective: To determine if circulating CD4+ lymphocyte counts are predictive of specific infectious or neoplastic processes causing pulmonary dysfunction.

Design: Retrospective, consecutive sample study.

Setting: Referral-based clinic and wards.

Patients: We studied 100 patients infected with human immunodeficiency virus (HIV) who had had 119 episodes of pulmonary dysfunction within 60 days after CD4 lymphocyte determinations.

Measurements and main results: Circulating CD4 counts were less than 0.200 X 10(9) cells/L (200 cells/mm3) before 46 of 49 episodes of pneumocystis pneumonia, 8 of 8 episodes of cytomegalovirus pneumonia, and 7 of 7 episodes and 19 of 21 episodes of infection with Cryptococcus neoformans and Mycobacterium avium-intracellulare, respectively. In contrast, circulating CD4 counts before episodes of nonspecific interstitial pneumonia were quite variable: Of 41 episodes, 11 occurred when CD4 counts were greater than 0.200 X 10(9) cells/L. The percent of circulating lymphocytes that were CD4+ had a predictive value equal to that of CD4 counts. Serum p24 antigen levels had no predictive value.

Conclusions: Pneumocystis pneumonia, cytomegalovirus pneumonia, and pulmonary infection caused by C. neoformans or M. avium-intracellulare are unlikely to occur in HIV-infected patients who have had a CD4 count above 0.200 to 0.250 X 10(9) cells/L (200 to 250 cells/mm3) or a CD4 percent above 20% to 25% in the 60 days before pulmonary evaluation. Patients infected with HIV who have a CD4 count below 0.200 X 10(9) cells/L (or less than 20% CD4 cells) are especially likely to benefit from antipneumocystis prophylaxis.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cryptococcosis / immunology
  • Cytomegalovirus Infections / immunology
  • HIV Antigens / analysis
  • HIV Core Protein p24
  • HIV Seropositivity / complications
  • HIV Seropositivity / immunology*
  • Humans
  • Leukocyte Count
  • Lung Neoplasms / immunology
  • Mycobacterium avium-intracellulare Infection / immunology
  • Opportunistic Infections / etiology
  • Opportunistic Infections / immunology*
  • Pneumonia / etiology
  • Pneumonia / immunology*
  • Pneumonia, Pneumocystis / immunology
  • Predictive Value of Tests
  • Retrospective Studies
  • Retroviridae Proteins / analysis
  • Sarcoma, Kaposi / immunology
  • T-Lymphocytes, Helper-Inducer*


  • HIV Antigens
  • HIV Core Protein p24
  • Retroviridae Proteins