Q and A

Question

Is a CD4 count under 100 bad?

I am a 25 year old male and just found out i am HIV positive.

Ihave a CD4 of 41 and a viral load of 3,500,000 copies/mL. I am told I need to start treatment.

What dose my CD4 and viral load mean? Is it bad? I’m feel really worried and scared.

Thank you all very much for your help.

Answer

Hi

I’m sorry to hear you are having a rough time.

It is never easy to find out your are positive. It is going to take time to get used to this and to learn about how this will affect your life, but it will get easier.

Your CD4 count is a measure of your immune system. to HIV

Your doctor is giving you good advice about the need to start HIV treatment (ART).

Your immune system is currently very vulnerable to infections – so the sooner you start ART the better.

Hopefully you may have already started by now, or are planning to start this week.

Because your CD4 count is below 50 you should also have an eye exam (for CMV). Until your CD4 count gets over 200 (and it will on treatment) you will also need to take an extra antibiotic medicine called Septrin to reduce the risk of other infections.

Your viral load is also very high. This might mean it is important to use an integrase inhibitor when your start. This will help bring viral load more quickly than other HIV drugs.

One caution to the advice above is if you are in very early infection. Most people with your results would be expected to have been HIV positive for many years and you have just been diagnosed late.

Sometimes people who were definitely HIV negative a year earlier who have a bad reaction to a very recent HIV infection. Even when this is the case, your results would still mean immediate treatment is recommended.

Once on ART your viral load should drop dramatically. Your CD4 count will slowly increase. So this is good reason not to worry or to be scared.

See the Introduction to ART guide linked from this page.

https://i-base.info/guides/

We can post you a copy if your clinic has not already given you this.

Also if you’d like to talk through any of this please call the phoneline on the number below in the signature.

Direct links to pages with information about CD4 and viral load are:
https://i-base.info/guides/starting/two-essential-blood-tests
and
https://i-base.info/guides/starting/how-does-cd4-count-relate-to-the-risk-of-becoming-ill

This answer was updated in January 2016 from a question first posted on 21 November 2011.

25 comments

  1. Roy Trevelion

    Hi Emme,

    Can I ask if yur wife has started HIV treatment (ART)? That’s because the START study showed that ART has important benefits for your health, no matter what your CD4 count.

    Please see this page from ART in pictures that shows what happens to viral load and CD4 count when ART is started.

    And here’s an Introduction to ART for more info about starting HIV treatment.

  2. Emme

    My wife’s CD4 count was 280. What’s the advice

  3. CJ

    I made mistake Roy my count was 137 not 237, my mistake.
    Apart from that I’m fine, just fighting knee transplant, it’s getting better but still bit painful. Only been 4 months.

  4. CJ

    Reply to Roy Trevelion.
    I’ve been shaking off flu
    I did have Blip many years ago now.

    Well fingers crossed.

    CJ

  5. Roy Trevelion

    Hi CJ,
    Have you had another viral load test to confirm it? It could be a viral load blip. These are common. Blips can be defined as an increase from less than 50 copies/mL to above 200, 500 or even 1000 copies/mL.
    Has anything changed recently? Blips can be caused by other infections, such as flu or herpes, or a recent vaccination.

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