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INTERPRETING YOUR LAB TESTS

A key to taking control of your health is learning to monitor your immune system. The bulk of immune monitoring is done through a
variety of blood tests. Learning how to read and understand your laboratory tests can be quite frustrating. This article will provide
basic information to help with this process. Because different labs reports results a little differently, it may be wise to ask your doctor
to help you read the results as well.
There are some basic rules which hold true for nearly all laboratory tests:
. !ifferent laboratories can get different results from the same sample of blood. "ake sure you ask your doctor which lab as
used if it was noted on the report.
#. Laboratories can make mistakes. $f your results have changes dramatically since your last test, have it run again.
%. "ost lab values have to be interpreted along with other clinical and laboratory data in order to develop a meaningful
diagnosis. &ery seldom will only one value give all of the answers.
'. Laboratory values differ according to age, se(, current medications, etc. Therefore, the interpretation of these values needs
to be done with these parameters in mind.
). The *normal* range is the value that is normal for a person who does not have +$& infection. ,or e(ample, a low cholesterol
value in an +$& positive individual is not uncommon.
COMPLETE BLOOD COUNT (CBC)
The complete blood count -.B./ is one of the most common tests offered by a doctor. $t is a routine test used to
evaluate the blood and general health. Asymptomatic, +$& positive people should have this test done twice a year.
0ymptomatic people should have their .B. done at least every three months. Additionally, if you are on anti1+$&
medication you might have to have this test more often. A .B. measures all of the following parameters: red blood
cell count -2B./, white blood cell count -3B./, hemoglobin, hematocrit, three red cell indices, and the white cell
differential. 4latelet cunts are sometimes included in a .B..
RED BLOOD CELL COUNT (RBC)
The 2B. count is the number of red blood cells in a cubic millimeter of blood. The 2B.s are the cells produced in
the bone marrow that carry o(ygen to your tissues. The normal rage is '.) 1 )15 million6mm
%
for men and '.7 1 ).%
million6mm
%
for women. A slightly decreased value is not cause for alarm as many individuals with +$& have
values below the normal range. +owever, a markedly decreased value should be thoroughly investigated. A person
with significant low 2B. count can have symptoms of fatigue, shortness of breath, and appear pale in colour. A
low 2B. count can be due to progressive +$& illness or to certain medications or both. A8T, for e(ample, can
suppress the production of 2B.s in some people. A decrease in the 2B. count usually causes a decrease in the
hemoglobin and hematocrit values.
WHITE BLOOD CELL COUNT (WBC)
The 3B. count is the number of white blood cells in a cubic centimeter of blood. The primary function of these
cells is to prevent and fight infections. There are many different types of white blood cells that play specific roles in
fighting infections. These specific types of 3B.s can be measured in a white cell differential. 9ormal 3B. count
is from ',)77 to ,777. The 3B. count can be decreased for a variety of reasons: certain medications decrease
their production in the bone marrow, minor viral infections which you may not even be aware of, stress, and
opportunistic infections can all change 3B. counts. &alues markedly decrease should be cause for concern, since
during this situation one is more susceptible to other infections.
HEMOGLOBIN
:(ygen is carried to the tissues via hemoglobin in the red blood cells. A normal hemoglobin level is ' 1 ; g6dl for
men and # 1 < g6dl for women. A slow progressive decline in hemoglobin is often seen in people with A$!0. This
is usually due to a decline in the number of 2B.s produced in the bone marrow. Any drug which causes a
suppression of the bone marrow will decrease the hemoglobin levels. $n most cases it*s a matter of balancing the
effects of the drug with it*s potential side effects. 3hen the side effects become too great, either the drug must be
discontinued or the dose reduced to a tolerable level. A drug which mimics the action of the hormone
erythropoietin -a.k.a. 4rocrit, =4: and newer brand names/, has it*s effect on the bone marrow causing the
production of new 2B.s. $t has provided great relief to thousands of individuals of people with +$& and kidney
dialysis patients. =4: has enabled many people to stay on bone marrow suppressive drugs without the need for
transfusions.
HEMATOCRIT
The hematocrit is the percent of the cellular components in your blood to the fluid or blood plasma. This test is one
of the truest markers of anemia. 9ormal values for men are '71)'> ad for women, %?1'?>. A decrease in
hematocrit is always seen with a decrease in hemoglobin. These two values are linked to one another.
MEAN CELL VOLUME (MCV)
The mean cell volume or ".& is the most important of the 2B. indices. $t is a measure of the average si@e of the
2B.. ,or those individuals taking A8T the ".& will always be normally elevated, i.e. greater than 77. &itamin
B# and ,olic Acid deficiency also causes increases in ".&. 9ormal ".& levels are ;7 1 5<.
PLATELETS
4latelets are cellular fragments which are necessary for the blood to clot. 3hen activated by trauma, platelets
migrate to the site of inAury where they become *sticky* 1 adhering to the inAured site and helping to form a fibrin
clot or scab. 9ormal platelet values are )7,777 1 ')7,777. $n some individuals, +$& itself causes a decrease in the
number of platelets. :therwise, drugs can also cause low platelet counts. =ven though counts are considered low
below )7,777, most people can survive without the threat of internal bleeding with counts above )7,777. :n very
rare occasions, the number of platelets present are adequate, but for unknown reasons they don*t function correctly.
Any malady involving one*s platelets can be a potentially serious condition.
WHITE CELL DIFFERENTIAL
The white cell differential counts 77 white cells and differentiates them by type. This gives a percent of the
different kinds of white cells in relation to one another. The three main types are: polymorphonuclear cells -4"9s/,
lymphocytes, and monocytes. 4"9s are increased during bacteria infections, while lymphocytes are decreased
with viral infections. $ncreased monocytes are sometimes seen in chronic infections. 9ormal percent of 4"9s is ))
1 ;7>. #) 1 ')> is the normal number of lymphocytes, and # 1 7> is normal for monocytes.
There are a wide range of blood chemistry tests which are done on individuals either routinely or for specific reasons. 0ome of the
ones pertaining to +$& are mentioned below.
CHOLESTEROL
.holesterol levels, as mentioned earlier, are routinely decreased in +$& positive individuals. $t*s not understood
why this occurs, but it is thought to be related to altered metabolism. 9ormal cholesterol levels are )7 1 #)7
mg6dl.
AMYLASE
Amylase is an en@yme that is secreted in the mouth by the salivary glands and also in the pancreas. $t can be an
early warning sign of acute pancreatitis when elevated. ddI can cause problems with the pancreas in a small
number of people taking the drug. 9ormal amylase levels are #) 1 #) milliunits6ml.
CPK or CK
.4B or .B is an en@yme that*s found in the brain and muscles of the body. 0trenuous e(ercise as well as heart
attack can cause increases in .4B. This makes clear the point of elevating an abnormal test result in the conte(t of
other factors. "yopathy, dysfunction6distress with the muscles, can sometimes be confirmed with an elevated .4B.
"yopathy is usually caused by +$& but can also b due to A8T, especially at higher dosages. 9ormal levels of this
en@yme are 1 ;7 milliunits6ml -%7 degrees7 or )) 1 ?7 milliunits6ml -%? degrees/. &alues will be slightly lower
for women.
LIVER FUNCTION TESTS
Liver function tests include ) 1 < individual tests which collectively can help determine the status of ones liver.
=levated liver en@ymes are most often caused by certain medications. The +$& positive population also has a high
prevalence of hepatitis. At least ' different viruses are known to cause hepatitis, all leading to increased liver
function tests. Therefore, compound factors can be at work. $f liver en@ymes are only moderately elevated, most
doctors will take a *wait and see* attitude, monitoring them over a period of a few weeks to a few months. +owever,
if elevation is quite high, the underlying factor must be found. This might very well be one of the medications that
you are currently taking. The names of these liver function tests include 0C:T, 0C4T, alkaline phos, total
bilirubin, and L!+.
KIDNEY FUNCTION TESTS
Two tests which measure kidney function are the BD9 and .reatinine. The usefulness of these two tests in an +$&
positive individual usually relates to medications possibly to(ic o the kidneys. +ence kidney function is monitored
in this way. ,oscarnet is an e(ample of a drug which can cause renal to(icity. 9ormal BD9 levels are 7 1 #7
mg6dl. 9ormal levels of .reatinine are 7.< 1 . mg6dl.
LYMPHOCYTE SUBSETS
The category of lymphocyte subsets includes absolute counts and percentages of .!' and .!; cells as well as
other parameters. Dsually the number and percent of B cells is included and the number and percent of all
lymphocytes -e(cept those called *natural killer* or 9B cells/. Lymphocytes are broken down mainly into .!'-E/
cell and .!;-E/ cells. $t is well known that +$& causes a slow progressive decline in the number and percent of
.!'-E/ cells in most individuals. There are e(ceptions. 0ome people progress in their disease rapidly and others
don*t seem to progress much at all after more than # or % years. normal .!' counts are %)7 1 )77. The role of
.!; cells is less clearly understood. =arly on in the epidemic, high .!; cell counts caused inversion of the
.!':.!; ratio and was thought to adversely affect illness. 9ow it is generally believed that elevated .!; counts
are advantageous since it*s thought to keep +$& somewhat constrained. 9ormal .!; cell counts in an +$&
negative person is #?) 1 ?;7.