CD4 count and guidelines
All guidelines recommend starting treatment based on your CD4 count. The lower it drops the more important your need to start.
UK guidelines recommend treating anyone whose CD4 count is below 350 and at higher levels if there are other complications.
This is because:
- With a CD4 count below 350 your risk of serious illness increases.
- Treatment will protect your immune system and increase the chance of reaching a ‘normal’ CD4 level above 500.
With counts just below 350, you still have time to understand your choices. This is true even just below 200 when a few weeks either way will not make much difference.
The further below 200 the higher the risk from delaying treatment.
Some guidelines (including the US, France and Australia) recommend starting treatment earlier, when the CD4 count falls below 500.
UK guidelines recommend treatment at CD4 counts above 350 if you have:
- HIV-related complications.
- Hepatitis B or C.
- TB coinfection.
- If you want to reduce the risk of transmitting HIV to sexual partners.
Some guidelines include being over 50 years old as a reason to start treatment.
No-one wants to take drugs every day and I certainly didn’t. I put it off til the last possible moment. Looking back I wish I had started sooner.
I still wonder whether the three years I spent waiting for my CD4 count to fall to 200 would have been happier and more active ones if I had started treatment when my doctor recommended, when my CD4 count was 300.
— Matt, Brighton