Question
My brother’s CD4 count dropped to single figures off-ART
1 January 2026. Related: Adherence, All topics, CD4 and viral load, Life expectancy, Stopping treatment.
Hi. My brother in the UK has lived with HIV for 20+ years. He had HIV one year before starting ART. I know his viral load was high and CD4 low. He was told then he has a ‘more virulent strain’ and was almost into full blown AIDS at that point.
He started ART and has been on it until 2 1/2 years ago he decided to stop.
He didn’t want to take the meds, so in July 2023, he stopped taking ART, but continued to get blood tests. He was ‘undetectable’ for many years before stopping, and got complacent (IMO) and decided HIV wasn’t a real thing, and he would be fine without the meds.
Two years after stopping, he told me in mid July 2025 his CD4 was in single figures, his specialist told him he has AIDS, and he must go back on HIV meds.
He said at that point he still refused. I tried to persuade him to go back on ASAP, but he said never again.
Now, after having spent all of Xmas 2025 & new year 2026 in bed, feeling ill, he’s decided to restart ART.
What are his chances of ART working now, of getting back to where he was before, and or his chances of survival now please?
Answer
Hi there
Thanks for your email and for including this level of detail.
It is really good that your brother has restarted treatment again. Talking through his history with the doctors might mean he is now taking newer meds that are much easier to take.
It also sounds like your brother has been very lucky in generally being okay over this time. The biggest risk was that he could have had serious complications over this time before he restarted treatment.
He will now get closer monitoring on the new meds to make sure he is supported.
There is still a very good chance that he will come through everything okay. Even with a very low CD4 count now, this can steadily recover over the next few years.
Everyone is different, but this might take about a year to get the CD4 count above 100 and another years to get it above 200, although this can sometimes be more quickly.
The next few months will also be important because about 1 in 4 people who start treatment with a CD4 count are at risk of IRIS. This is when symptoms from other infections are recognised as the immune system gets stronger again.
IRIS can be very serious, but is usually treatable if the doctor is looking out for new symptoms.
Comment