Question

Do I need ART if my CD4 is still above 500 after 24 years?

28 March 2024. Related: All topics, CD4 and viral load, Starting treatment.

I tested HIV positive 24 years ago and my CD4 count now is 501.

My viral load is 1300, without any kind of medication what’s your advice can I consider taking pills now ?

Answer

Answer: Simon Collins

Hi there

Thanks – this is an interesting Q – and is one of the situations where HIV treatment guidelines are unsure.

This is because there is very little evidence to show what is best, just information from different studies for you to use when talking to your doctor.

In general, since 2016, all guidelines that everyone living with HIV can benefit from HIV meds (ART). This is because the START study reported ART protects against serious health problems even when someone still has a strong CD4 count above 500.

This is because having a detectable viral load keeps your immune system in a state of inflammation and over activation. This increases the risk of health problems. Even at low levels, continuing to have detectable viral load might be increasing your risk over so many years, even though levels are still low.

So most doctors recommend everyone should be on ART, including someone with your results. They also recognise that there is limited data for people in this group.

Modern ART is easy to use, involving only one pill a day and with no or negligible side effects. However, if you are unlucky and have difficulty taking ART, then the risk on not being on ART might also be so low that you can just be monitored without using ART.