Question

What do it mean if your CD4 count is 200 or less?

5 February 2018. Related: Access to treatment, All topics, CD4 and viral load, HIV transmission, Starting treatment, Support.

My partner did her first CD4 test this December and it turned out she had a CD4 count of less than 200. She got to know she was positive in April when I also got to know her. Her viral load is not known as that test is rare in developing countries.

My questions are:

1. What are the things you read or come to your mind if someone’s first test is a CD4 count of less than 200?

2. Speculation is not good but since we cannot accurately estimate time of infection then we may only speculate with some backing of scientific HIV facts. Approximately how long does an infection lead to a CD4 count of less than 200 if we can speculate :) ?

3. We do not know who was infected first but my CD4 count since April has been above 650 and my viral load is 1200 from a last test this week (I am not on any medication yet). What do you read or what can your more reliably assume from a comparison of our data?

4. She started medication but I have my fears as we are from a developing country medical access has been very hard for her.

Thanks

Answer

Answer: Charlotte Walker

Thank you for your question.

How are you both doing? Even though finding out you are positive can be difficult, it does get easier. Effective HIV treatment (ART) is now widely available even if access to some tests (like viral load) is sometimes more difficult.

Answers to each of your questions are below.

1. A CD4 count of 200 or less is a sign that HIV is more advanced. This means it is more important to start ART. This is because once the CD4 count drops below 200, the risk of other infections increases. Until the CD4 count becomes higher, using a daily antibiotic, combined as co-trimoxazole (often called Setrin or Bactrim) prevents pneumonia and other infections. For more information on CD4 count and the risk of becoming ill please follow this link.
2. HIV affects people very differently. Even if two people both become HIV positive with the same virus at the same time, one might progress very quickly and the other very slowly. There are also no tests that can show how long someone has been HIV positive. Even if there were a test, the most important thing for both of you now is looking after your health and looking forward to the future.
3. As with question 2, it is impossible to know who became positive first and for how long. As above, the most important thing is to focus on both of your health. Ift is good that your partner is already on ART as since 2015 this has been recommended for all HIV positive people, even with a high CD4 count (above 500). Even though your CD4 count is currently strong, please talk to your doctor about this. Your risk from HIV are currently low, but being on ART reduces these further. Good information can help when talking to your doctor. For example, please see the i-Base Introduction to ART guide.
4. Some countries definitely have fewer choices of treatment and related tests – although this is getting better. Even when viral load is not available, the meds will still work for your partner though.

Note: this answer was updated in February 2018 from a question first posted in December 2010.