Late diagnosis and low CD4s
In the UK, half of all new diagnoses are in people whose CD4 count is already less than 350. This is the threshold to start treatment.
25% of people are diagnosed even later with a CD4 count of less than 200.
These late diagnoses are related to:
- Fear of testing.
- Denial: ‘it will never happen to me’.
- Fear of stigma and prejudice.
- Lack of up-to-date information about HIV and treatment.
Some people, across all age ranges, only find out they are HIV-positive when they become ill and are admitted to hospital.
This often means starting treatment straight away, especially when the CD4 count is below 100.
Even with a very low CD4 count, even below 10, if you follow your treatment very carefully, you have a good chance that treatment will work. Your viral load will drop and your CD4 count will rise to safer levels.
This should not be seen as an option to delay treatment. Starting with a very low CD4 count can cause some infections, such as TB or CMV to activate. This is called Immune Reconstitution Inflammatory Syndrome (IRIS).
I got a shock diagnosis in January 2002 and immediately worried about dying. I pictured myself as a person in the media adverts for African people with AIDS, who were just bones and skin.
My viral load was 650,000 and my CD4 was less than 10. Therefore I had to start ART immediately.
I read the leaflets and could not believe I was on treatment for HIV! I was only sleeping for two hours a night with very vivid dreams — mainly nightmares related to the ARV efavirenz.
Because my CD4 count was so low when I started, the increase in CD4 cells caused TB to activate. So I started on TB treatment, taking up 18 tablets a day but I asked the pharmacist to give me one of the TB meds as an oral solution as I couldn’t swallow the large grey tablets.
Now, seven years on, I take my HIV medication every day and at the right time. I would love to go back to home, but a lot of people in my country have no access to ARVs.
— Memory, London