Question
Do AIDS defining infections occur at high CD4 counts?
3 November 2021. Related: All topics, Living with HIV long-term, Opportunistic infections.
I am 30 years old, HIV poz. I have been on ART close to 3 years. I have a good CD4 of 800 – 1000 and VL has been not detected since 3 years on ART.
My question is: how often do you come across with cases of AIDS defining illness although they have good CD4 counts and undectectable VL?
For example: I have had syphilis, but is there a chance i can still have neurosyphilis because of i am living with HIV? What about TB, do PLHIV with good CD4 has the same probability of getting active TB disease like people with low CD4?
Answer
Hi there
Thanks for your questions – and great that you are doing so well on treatment.
The risks for nearly all HIV-related complications are closely linked to the CD4 count. These are very rare when the count is above 500. The risks get steadily higher though the lower the CD4 count drops below 200.
A few infections can occur when the CD4 count is above 350. These include TB and a few HIV-related cancers. But the overall risks are still lower compared to having a lower CD4 count.
Testing, monitoring and treatment of syphilis should be the same though at any CD4 count. You are not at higher risk of neurosyphilis.
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