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. Most guidelines now recommend treating anyone whose CD4 count is below 350 and all recommend treating before it falls below 200.
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 have time to understand your choices. This is true even just below 200 when a few weeks either way will not make much difference.
In December 2009, the US guidelines recommended treatment for anyone with a CD4 count below 500 and an option to start above 500. UK guidelines in 2010 are unlikely to change from the current cut-off of 350.
Guidelines also recommend that you consider treatment, whatever your CD4 count, if you have:
- An HIV-related illness
- Hepatitis B or C
- TB coinfection
- A high risk of heart disease.
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