Q and A

Question

Can I work out when I was infected from my CD4 count?

I have recently been screened as HIV-1 positive. My CD4 count was 114 (11 %) and had a viral load of 1200000 on September 5, 2011. As I had herpes zoster this summer and very low CD4 count my therapist suggested that I might have been infected some 6 years ago. I immediately started ARV therapy: Kaletra (lopinavir 200mg + ritonavir 50 mg) 2*2 a day and combivir (lamivudin 150 mg + zidovudin 300 mg) 2*1 a day. After one month of treatment now my CD4 count was 236 (17 %). I developed no symptoms my lungs and organs are all okay.

Is it possible that the extremely high load of virus means that my infection is a recent one or on the basis of the CD4 count it is really a six year one?

On the basis of the diagram ( plotted in your issue here) on the expected increase of CD4 cells when starting treatment at 114 this is something of a good piece of news, as it should be this after one year. Does this increase mean anything?

Thank you for your answer and thank you for being here.

Answer

There really is no accurate way to know how long someone has been HIV positive.

The best guess is based on your risk of exposure together with CD4 and viral load. However, one set of CD4 and viral load tests gives you no idea about which direction your counts were travelling in.

One option is that this could be either recent (and you were diagnosed during a difficult seroconversion). This might mean that the next counts could improve without treatment.

Another that you have been positive for a number of years and your results showed chronic infection – whether this was 3, 5, 8 or 10 or more years ago. A second set of blood test wold probably be worse, but with a CD4 count of 114, this isn;t something you would want to risk.

If you remember a p0tential exposure, especially followed a few weeks later by a heavy flu, this would support that as the time of infection. But not everyone gets symptoms or can remember these.

If you think this may have been less than 6 months ago a detuned HIV test can indicate an infection less than 6 months old.

This test is sometimes only available in some research centres. It used to be called STARHS and is now referred to as RITA (Recent Infection Testing Algorithm). In the UK newly diagnosed people receive the result from this test, though it is not always reliable for individual cases.

I’m not sure which i-Base article or diagram you referred to as there was not a link in your question.

10 comments

  1. Getrude

    Recently my boyfriend tested HIV+ with a CD4 count below 21what does dis mean how long has he been HIV+?. I find it hard to belive dis as I have tested negative…

  2. Lisa Thorley

    Hi Gertrude,

    Its not possible to say how long someone has been positive for from their CD4 count. For why you’ve tested negative, please see Q5 here:

    https://i-base.info/qa/what-are-the-most-asked-questions

    Your boyfriends CD4 is low. Therefore, its important that he starts ARVs as soon as possible. He will also need to follow the advise that’s in this link:

    https://i-base.info/qa/4643

  3. Lisa Thorley

    Hi Charmaine,

    Its not possible to tell from a persons CD4 count when they were infected. To know this, you will need to think of any risks that you may have taken.

    I’m not sure what you mean by a kidney 24, could you please explain this?

    A CD4 of 274 means that you should be on treatment. Once you’re on treatment, your CD4 will rise.

  4. charmaine

    My CD4 count is 274, and my kidney is 24, is this fine?
    When did I pick up this HIV?

  5. Lisa Thorley

    Hi Dumi,

    A CD4 count cannot tell when a person contracted HIV. Therefore, it could have been either of you. The only way to know is to think about your sexual histories.

  6. Dumi

    I tested positive on 23 of march 2016 and my CD4 count was 580 and my girlfriend whom I had started dating 8 months prior to my testing came back with a CD4 count of 200 and she was accusing me of infecting her. Can it be true?

  7. Rebecca McDowall

    Hi Thuli,

    HIV shouldn’t cause any pain during intercourse. This can be caused by stress or by another infection and it’s a good idea to talk to your doctor about this.

  8. thuli

    My cd4 count is 620 viral load 40 and I’m trying to get pregnant and now I’m expiriencing pains in my stomach while I’m trying to intercourse

  9. Simon Collins

    Hi

    Your boyfriends CD4 count is very low. His doctor should be talking about a full health check including vision. He should also emphasise the likely importance for starting HIV drugs.

    You can’t tell how long someone has been positive from their CD4 count. However, a CD4 count below 200 is usually and indication that this is likely to have been at least several years.

    It is good luck that you have managed not to catch HIV. This does not mean that you can not catch HIV in the future though.

    Now you both know your status, using condoms will protect you. If your boyfriend gets an undetectable viral load after starting HIV treatment, this will also make him less infectious. HIV drugs need to be taken seriously with near perfect adherence. This means getting into a routine where no doses are missed.

  10. MissK

    Recently my boyfriend tested HIV+ with a CD4 count below 40 what does dis mean how long has he been HIV+?. I find it hard to belive dis as I have tested negative…

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