Q and A


Are there side effects from starting ART with a low CD4 count?

Feb 2022 I tested positive. My first CD4 count in March was 57 and 7%. Viral Load was around 57000. My symptoms were oral thrush and a skin rash. Started treatment in Mar:

April CD4: 92 and 10%; Viral Load: ~500
May CD4: 173 and 12%.

My treatment is dolutegravir and Truvada. I also take one Septrin per day. Do you have any information on the long term risks of starting treatment from such a low CD4 count? Or what the chances are of making a recovery? I’m 52 year old male.
Oral thrush and skin problems persist even though I’m taking various treatments for both. Thanks


Hi, how are you doing?

I am sorry to hear that you have only recently tested positive. Have you had any support/doing okay coping and adjusting?

There are no long term side effects from taking ART at lower CD4 counts. You will not experience different side effects than if you were to start at a higher CD4 count.

It is great that you started treatment so soon. As you can see, the medication is already working really well for you and for your CD4 count to recover this much so quickly is a very good sign.

As you continue with your HIV medication, your CD4 count will increase. Starting at a lower level of CD4 count does mean you may not recover to within the range of someone without HIV. In this case there are possible long term side effects however it is not definite. Lower CD4 counts are associated with greater risk for other illnesses. Starting at a lower count may mean you do not recover to the point of no risk.

In the UK – above 200 you can stop taking Septrin (this may be different in your country) and long term side effects are greatly reduced. It is likely you will get an increased CD4 count due to how well your body has responded to medication.

CD4 changes in response to treatment is much slower than viral load, but yours is still increasing at a very promising rate. Those who are HIV negative have a CD4 count between 430 and 1690. When your count is lower it means your immune system is less effective. This will explain the persistence of your symptoms. It is also why you are on Septrin.

Becoming undetectable for a viral load can take up to 3 months, but usually this is within the first month of treatment. You are responding really well, it is likely your result will be undetectable soon and this is very suggestive of your long term health. This is also true for CD4 count.



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