In a patient with acute HIV infection, does the total White Blood Cell (WBC) count in the Complete Blood Count (CBC) decrease or remain normal during the acute symptomatic phase?

White Blood Cell Count During Acute Symptomatic Primary HIV Infection

During acute symptomatic primary HIV infection (acute retroviral syndrome), the total white blood cell (WBC) count more commonly remains within the reference range rather than consistently decreasing. [1]

Leukopenia (low WBC) occurs in a minority of patients during primary infection, with a reported prevalence of 24.8%. [1]

Clinical Interpretation of CBC Trends

A decrease in total WBC count is therefore possible during the acute symptomatic phase. [1]

However, most patients do not develop clinically significant leukopenia, so the overall pattern is “normal or mildly decreased” rather than a uniform decline. [1]