Q and A


My friend is having big problems after starting ART with a low CD4…

Hi, my friend was diagnosed hiv positive a month ago and also started treatment the same day that he found that he is hiv positive. They took blood and his cd4 count was 34 two weeks after starting treatment. My question is now he is talking things that don’t make sense and his hands shake and he can’t walk properly.



Thanks for writing – your friend is very lucky to have you there to support him.

Although it is very good that he is now on HIV treatment (ART), this is slightly complicated because his CD4 count was so low when he started.

The symptoms you describe have the potential to be very serious because they affect his speech, brain and balance. So it is important that he see’s a doctor as soon as possible. They sound like an HIV-related infection rather than a side effect.

This is because in the first few months on ART, new infections can sometimes become active. This is called IRIS and is a sign that the immune system is getting stronger, But the doctor needs to look at all possible causes, so that the other infection can be quickly treated. Infections that cause IRIS can be difficult but are usually treatable

Please get back to me if you have other questions or to let me know what happens.


  1. Simon Collins

    Thanks for this extra information.

    It is definitely good news that they didn’t find TB.

    However, there could be other infections that could cause these symptoms in people with a CD4 count under 50.

    Can I ask whether your friend is seen in a larger hospital in the city or at a smaller clinic somewhere else? This is because other tests are sometimes only available in larger hospitals.

    Also, did the clinic also give your friend antibiotics called co-trimoxazole? If yes, then these antibiotics could help treat so of the infections that cause similar symptoms.

    I am not a doctor, but in the UK these symptoms would lead to more tests. Please help your friend keep a record of if the symptoms get better or worse. For example, write down when they happen each day in case there is a pattern.

    If they don’t get better over the next week, I would go back to the doctor. If they start to get worse, I would go back sooner.

    I have posted this as a comment and answer online in case you are reading it there. My last email to you bounced back.

  2. Anon

    He went to the clinic on Monday to collect his meds and also checking the result of TB and they found out that he doesn’t have TB. He complained about his speech and balance and brain. They told him those things they accur and normally go away. The question is he want to know they last for how long before they go away?


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