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The concentration of CD4 T-lymphocytes (CD4 count), in a person's plasma iswidely used to decide when to start HIV-positive people on anti-retroviraltherapy (ART) and to predict the impact of ART on the future course of HIV andtuberculosis (TB). However, CD4 cell-counts vary widely within and amongpopulations and depend on many factors besides HIV-infection. The way in whichCD4 counts decline over the course of HIV infection is neither well understoodnor widely agreed. We review what is known about CD4 counts in relation to HIVand TB and discuss areas in which more research is needed to build a consensuson how to interpret and use CD4 counts in clinical practice and to develop abetter understanding of the dynamics and control of HIV and HIV-related TB.

HIV, TB and ART: the CD4 enigma