Q and A


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

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.



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.


  1. vina

    HI,is there hope for a cure soon? I’ve a partner who is really tormented.

  2. Lisa Thorley

    Hi Mpumi,

    You should be taking bactrim at least until your CD4 count is 200, if not 350. Therefore, if you can you should ask for more bactrim. This is because your CD4 is less than 200.

  3. mpumi

    hi I’m Mpumi
    its been a month since I’ve started my ARVs with a CD4 count of 57. I was give bactrime and vitamin b tablets. When I went for my 2nd visit to the clinic to fetch more ARVs I was given ARVs for 2months and bactrime that will last me only 1 month.I will do my second test in 2months time to check how low or high my CD4 count is. My question is should I be worried that I was not given bactrime that will last me until my next CD4 count tests?

  4. Arthur


    if she is now on treatment she should recover her cd4 count. She can’t miss any doses. My cd4 once dropped to 48, my Dr was able to switch my meds and put me on bactrim and azithromicyn and had them up to 208 jn a couple of months, just had new labs next week, hoping to be up close to 500. It’s all about taking every single dose.


    Don’t wait to start treatment, if your doctor is making you wait for some unknown reason, go to your local decent size hospital emergency room (not an urgent care) and they can and will prescribe HIV medication.

    Best of luck to all. Remember it’s no longer a death sentence.

  5. Lisa Thorley

    Hi Melkam,

    How is your mother doing with the ARVs? Is she also taking any other medication, like for example co-trimoxazole? If she isn’t taking co-trimoxazole then this is something that she should be taking. Because her CD4 is low she will also need to have her eyes tested and be closely monitored. For more information about what it means to have a low CD4 count, please see here:


    What’s important to understand is that the ARVs will have started to work as soon as she began them. This is good news as this means her CD4 count will improve and her viral load will begin to decrease. All of this can take some time. It will though, happen.

    With regards to life expectancy, as long as your mother takes her meds, her HIV will be controlled. Therefore, there is no reason why she can’t survive. However, none of us can predict how long someone will live. The important thing is that she’s on medication. Medication and support is what she will be needing at the moment.

  6. Melkam

    Hi my mom is HIV + and her CD4 is 36. She start treatment just 2 month, she is 52 years old so my concern is can she survive?

  7. Lisa Thorley

    Hi Samuel,

    Thanks for the positive feedback.

  8. Samuel

    You people are really doing great job.

  9. Lisa Thorley

    Hi Justin,

    As you have infections it is important that you are treated for these. This is even if you are not starting meds until the end of November. The following link explains what you need to do with a very low CD4 count.


  10. Justin

    Hi my cd 4 count is 16. And I haven’t started the treatment, Here I have to wait untill 29th of this month, but I have some inflections, what should I do before the treatment?