Q and A


Can I start treatment with a high CD4 count?

I HIV positive and thinking of starting treatment.

My CD4 cell count is still high (above 500), but I have heard that you can start treatment earlier if you want to.

Can I start treatment early, and what are the advantages and disadvantages?



UK guidelines recommend that everybody can start treatmentat any CD4 count. This includes CD4 counts that are higher than 500.

Similar recommendation are included in the US and WHO guidelines.

A few countries only recommend ART after the CD4 count drops to below 500. So the guidelines for your country will be important.

Advantages ofr starting above 500 incude:

  • Keeping a high CD4 count.
  • Reducing the risk of other illnesses. This includes both HIV and non-HIV complications.
  • Reducing the risk of transmitting HIV to your sexual partners.

These potential benefits outweight the potential disadvantages.

Disadvantages include:

  • The risk of side effects. But this risk is low and even if side effects occur they are usually mild.
  • Changing your life to make sure you take your meds on time. Many combinations only involve one pill a day.
  • A small risk of drug resistance if your treatment doesn’t work.

The START study provided much of the evidence on the benefits of earlier treatment.

There are some situations where treatment is strongly recommended at higher CD4 counts.

  • If you are coinfected with Hepatitis B or C you would be recommended to start treatment if your CD4 count was less than 500.
  • If you presented with an ‘AIDS defining illness’ (such as Kaposi Sarcoma) you would be recommended to start treatment regardless of your CD4.
  • Starting treatment for people in the UK who are worried about transmitting HIV to their partners. This is because of evidence that shows that ART dramatically reduces the risk of transmission.

The i-Base Introduction to ART answers many questions about starting treatment.

 This answer has been updated several times from a question first answered in October 2011.


  1. Lisa Thorley

    Hi Lindiwe,

    Its ok to have without a condom once your viral load is undetectable. Please see here: http://i-base.info/u-equals-u/

  2. Lindiwe

    Hi. I’m HIV + and my cd4 is 503. I started taking treatment and want to know when it is recommended to have sex without a condom. My partner is negative but he wants to know when it will be safe for him to stop using a condom?

  3. Roy Trevelion

    Hi Lisa M,

    A CD4 count of 729 is strong, and viral load at 2509 is low but not undetectable.

    Do you have access to HIV treatment (ART)? If you do and you’ve not started ART yet it’s good to know that it’s recommended now to begin ART at any CD4 count.

    If you are on ART, have you been on it for a while? Or have you just started. And what meds are you taking?

  4. Lisa m

    I’m HIV positive an my CD4 count is 729 and my the viral load of 2509 am I undetectable?

  5. Lisa Thorley

    Hi Leonia,

    Though you may be worried about your CD4 count. A CD4 count of 336 on diagnoses isn’t that bad. Many people are diagnosed with CD4’s even in single digits. As soon as you start taking ARVs’s your viral load will begin to drop. Your CD4 count will also rise. Please see here: http://i-base.info/guides/starting

    You won’t develop AIDS.

  6. Leonia

    My cd4 count is 336 and my viral load is high,a month ago I was tested positive and am on stage three,,can starting art help or lower my chances of developing aids.

  7. Lisa Thorley

    Hi Jacqueline,

    This means that your HIV is under control. You’re doing really well. You also can’t HIV when having sex without a condom. Please see here: http://i-base.info/u-equals-u/

  8. Jacqueline

    My cd4 is 425 and vld is undetected what does that mean

  9. Roy Trevelion

    Hi Unknown,

    A CD4 count of 817 is strong. Your CD4 count can tell you how well your immune system is working. The normal range for someone who is HIV negative is between 460 and 1600. So anywhere in this range is good.

    Have you been HIV positive long? Current HIV treatment (ART) is now recommended for all at any CD4 count. You can read more about HIV treatment in this Introduction to ART.

  10. Unknown

    Hi, I’m HIV positive and my cd4 count is 817, what does that mean?


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