Late diagnosis and low CD4s
In practice, most people are diagnosed when their CD4 count is already below 350. Even in the UK, one third of people are still diagnosed when their CD4 count is already less than 200 cells/mm3.
This is related to many factors, including:
- Fear of testing
- Predudice
- General denial: ‘it will never happen to me’
- Fear of stigmatisation
- Lack of up-to-date information about HIV
Many 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 cells/mm3.
Even with a very low CD4 count, even below 10 cells/mm3, 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 again to safer levels.
This should not be seen as a reason to delay treatment. Starting with a very low CD4 count can often cause dormant infections, such as TB or CMV, to activate. This is called Immune Reconstitution Syndrome.
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