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.
she took fixcom 4 for six months and she’s taking fixcom 3, but she missed it for a couple of weeks. what is possible result of this and what should we do..? thank you..
Hello Sir, My mom 54 yrs old, is suffering from gland TB. just on the right neck. she was taking her med since December 12, 2011. and her doctor said that she should take her med for nine months and it will end on September 2012. and the doctor said that she should not missed taking it. but the problem is, she stop taking her med for a couple of weeks till now. i’m so afraid for what is possible result of this.. what should i do? thank you!
I’m sure this is fine, but I don’t know the details of your meds or wether you are taking other medicines that would interact with them. Sometimes meds specify morning or evening, but Usually you can chose whenever is best for you to take your meds.
All meds should include information about how they should be taken, or a doctor or pharmacist can double check this for you.
Good day, quick question, is it a problem if i take my TB treatment (rifafour)at night before i go to sleep?thank you.
We are not doctors. You should speak to your doctor who prescribes your TB medications if you think you are pregnant. Your TB meds are important to take to protect your health.
Hie doctor thank u for your previous advice u gave us.i now have another problem i belive am pregnant wil take test later today.my problem is i cant afford a baby now.right now am on rifafour n my cd four count is 475.my husband n i hv seriously thot this thru n hv opted for an abortion,howeva am scared twil highly decrease my count and make me sick.plz help me out
I am not a doctor, but only with these brief details it sounds like the second doctor is giving you good information. In the UK, someone with a CD4 count between 100 and 350 can wait for two months after starting TB meds before starting ARVs. Also, it would be rare for anyone to start both TB and ARVs at the same time. Even when the CD4 count is less than 100, the recommendation is start ARVs as soon as possible, but this usually means within two weeks. This is to minimise two sets of side effects, especially when, as in your case, there is no urgency to start ARVs immediately.
You are also right that ritafour (the four-drug TB combination) is only used for the first two months, reducing to a two-drug combination afterwards. In the UK, the recommendation for TB meningitis is for the second part of treatment to last for seven months (total nine months TB treatment).
If you or your doctor want to see the UK (BHIVA) guidelines, the direct PDF file is linked here. See pages 6 and 15 of this PDF – or search the PDF for “meningitis”.
http://www.bhiva.org/documents/Guidelines/TB/hiv_954_online_final.pdf
In early May 2012, I was diagnosed with TB meningitis and also my CD4 count was 169. On the 9 May I started both TB (rifafour) and ARVs until now. I have been experiencincind dizziness everyday since I started both medications. My joints are still and fingers swollen. My knees can hardly stand. I have to be held by someone by hand when walking because I constantly fall because of weak knees. When I’m sitting down it’ s a mission to get up because of the knees. Having experienced this I went to the doctor who is not treating me for his opinion on these side effects. He said my doctor should not have started me on tb treatment and arvs at the same time. I should have waited for two months. How true is this as I want to consult my doctor to discuss this. Secondly my doctor said I should take rifafour for 6 months whereas the other doctor said rifafour is only for the first two months; then REFINAH. I m confused which is which?
Hi Sizwe,
Your friend’s doctor is right that your friend has been very strong not to get sick already. Some people don’t get ill until their CD4 is very very low, but this is unusual. When the CD4 count is low this means your body has lost the ability to fight lots of different infections. But this isn’t a guarantee that you will get sick- it just means that it is likely.
About 25-50% of people with a CD4 count below 50 who start treatment experience symptoms of IRIS (Immune Reconstitution Inflammatory Syndrome). This is where the immune system, as it starts to recover, suddenly realizes that there are a lot of infections it has to fight against that it was previously to weak to react to. This can cause infections like TB and CMV to show and patient can sometimes start to feel quite ill. However, the good new is that w hilst IRIS can make things a little more complicated, it is easy to treat. For more information please follow this link. IRIS: A concern for people starting HIV therapy
If your friend’s CD4 count is 13 then they need to start HIV treatment right away. For information about starting treatment please follow this link to our guidebook Introduction to Combination Therapy.
Hi Thoko,
I am sorry to hear about your and your husband’s recent diagnoses. But I’m glad to hear that the information on our website has helped you to feel confident about taking your medication. By taking your TB and HIV medications as they are prescribed by your doctor you both have a good chance of living long and healthy lives. So-called immune boosters do not work to boost your CD4 count and are generally a waste of money. The best things you can do to stay healthy are to take your TB medications for the full course, eat healthily and stay positive. Please let us know if you have any further questions. You and your husband might both benefit from reading our Introduction to combination therapy guide which has lots of information about starting HIV treatment.