There are a number of pathophysiological causes for a normal or raised CD4 count in the context of progressive HIV infection. These include
various co-infections, previous splenectomy, and lymphoproliferative disorders. Such circumstances can both confound HIV diagnosis and delay initiation of chemoprophylaxis and highly active antiretroviral therapy (HAART). We describe the case of a patient co-infected with HIV and
human T-cell lymphotropic virus type 1 (HTLV-1) who, prior to HAART initiation, was found to have progressive immune deficiency associated
with a raised CD4 count.