Question
Do I need to take ARVs as well as TB meds with a high CD4 count?
7 February 2023. Related: All topics, Opportunistic infections, South Africa, Starting treatment, TB.
I tested positive in South Africa in 2009 and my CD4 was 240 and in December 2010 I started treatment. It was for one month only. I was okay with it, it never gave me any problems but on the following month I never went to the clinic, so i started using Bactrim and some boosters.
Then in May 2011 I was raped by unknown guy and when they took my blood to check for my CD4, and the result was 500. At the same time they discovered that I’ve got TB. Now, since I am taking TB treatment, should I also start ARVs? I am worried.
Answer
NOTE: this question from 2011 has been updated to cover guidelines for HIV and TB treatment in 2023.
Thanks
The short answer is yes. Both these meds are really important.
It is especially important if you also have TB. And HIV treatment is recommended for everyone, even with high CD4 counts. This is an example of how guidelines have changed since you were diagnosed.
I am also sorry to hear about the assault. I hope you have been able to access care and support to help you get back to your life again. You are doing a great job at bring back your focus on your own health. This is important and your strength is an example to other people.
Your first CD4 results might just have been low if you were only recently infected.
In most people the CD4 recovers again, before it steadily drops over many years. It is great that your CD4 count has gone up, but the years that you were not on treatment would still have been damaging your immune system. You can still access treatment now if you go back to your clinic.
Unfortunately, there is no such thing as an ‘immune boosters’. This is just adverts and marketing. So-called ‘immune boosters’ will not help your CD4 count – only HIV meds can do this.
This question was updated in 2023 and 2021 from a question posted in 2011. This is because guidelines now recommended HIV treatment for everyone with TB.
Hi Tuli
Without more details I can’t say how your sister should be treated. This will be individualised based on other aspects of her health, including HIV and her CD4 count.
Her CD4 count may improve after she has started the TB meds.
UK guidelines (BHIVA HIV and TB guidelines 2011) say that if someone’s CD4 count is less that 100, that HIV meds should be started as soon after TB meds as possible, usually after the first two weeks.
If the CD4 count is between 100 and 350, HIV meds can be started later, usually after the first two months of TB meds, when the TB treatment is also usually modified to need fewer TB meds.
Hi, Simon
My Sista has tested positive last year and she never told anybody the CD4 her count was 3392 and now its 186 and we found out she has TB and she only started treatment last week. Are the TB Meds going to help her CD4 count not go down now that she is taking them because the Doctor said she will start the ARV’s in two months and the nurses at the clinic where she went to take her TB treatment said their doctor would have adviced her to start ARV’s in two weeks. What can help her CD4 count not to go down any further and which option that is going to help her?
Hi
This is a reason to contact your doctor straight away. This sounds more like an allergic reaction to the Bactrim and your doctor needs to see this.
http://www.rxlist.com/bactrim-drug-center.htm
This is much more important than starting ARVs.
Your CD4 count is still very strong.
In some countries people start at about 350 and in some still at 200 so this will depend on the recommendations in your country. In a few countries people can start at higher levels.
Hi, just got tested and my CD4 count is 352. I want to find out wen I can start the ARVs. I am currently on bactrium and my whole body is itching and has blisters that leave dark ugly marks. Could this be an opportunistic infection? Thank you
Hi Kumar
It is good you have started meds. Trustiva is a good combination and you should start to see changes in your CD4 count within the first month. It is important that you also take your TB meds. Your TB meds will make you feel better within the first few weeks too, but it is important that you take the full course of treatment.
If you have difficulty with eating then eating food that is liquid or softer is essential. You need this to keep your strength up. Not just juices but soups and broths etc. Your doctor should be able to help with this. Are you able to get false teeth to help in the future?
Hi Betty
This is a question that nearly everyone asks. While taking care of your health will help it will not significantly increase your CD4 count.
So far, only ARVs have proven this again and again in careful studies.
Keeping physically and mentally active, eating a balanced diet, reducing stress, and stoping smoking will keep you healthy in lost of other ways.
i tested + in 2007 n am not yet on med. my CD4 is 319. my question is, is it possible to boost it without being on med?
Please go back and talk to your clinic.
Your TB meds are important to you health and you need to find a way to continue the course.
Some other things may help, these include:
Bath or shower in cool or warm water rather than hot water as this can irritate your rash.
• Do not use heavily scented or coloured soaps and shower gels. Try to use products that are marked hypoallergenic or wash with aqueous cream.
• Use liquids and not powder to wash your clothes as tiny amounts of powder can build up on your clothes. Try using non-biological makes that are designed for sensitive skin.
• Wear cool fibres such as cotton rather than synthetic ones. When possible at home wear as few clothes as possible.
• Try not to use too many bedclothes. Keep as cool as possible in bed as being too warm can irritate your rash. Again, use natural, cool fibres such as cotton.
• Calamine lotion can be soothing when a rash is irritating.
I HAVE BEEN TAKING TB TREATMENT FOR ALMOST THREE WEEKS NOW, LAST WEEK I STARTED ITCHNG AFTER I TAKE MY TREATMENT, NOW ITS BEEN A WEEK, I WENT TO THE CLINIC THEY GAVE ME THINGS TO HELP ME WITH THE ITCH, BUT IT DIDNT DO ME ANY GOOD, I CANT SLEEP, I ITCH….IT LAST ABOUT 6 HOURS AFTER MY DAILY DOSAGE, ITS GETS UGLY AND WORSE, WHAT AM I SUPPOSE TO DO, I WANT TO DRINK MY TABLETS BUT THIS ITCHING IS REALLY SORE NOW, CANT TAKE IT ANY MORE…..PLEASE HELP ME
Hi
I’m sorry but this is a project based in the UK and I don;t have information about your local healthcare system to answer this.
I would expect that if you transfer to private care you may have to pay for your meds.
It is really worth persevering with the clinic. Your CD4 count may now be lower than 350 and in many countries this is a reason to start meds. This is the case whether or not you have TB so it is important.