Question

My CD4 is 350,is it safe to wait before starting treatment?

30 November 2011. Related: All topics, CD4 and viral load, Newly diagnosed, Starting treatment.

I have been given a first diagnosis of a CD4 Count of 350 and a viral load of 16000. My doctor said I should wait for another CD4 test before going on medication. Is this normal? I am worried that I should of started medication now, havign a CD4 count so low.

Answer

Answer: Li Marhaban

Your doctor has given you good advice.  The UK Guidelines (BHIVA), recommend people who been recently diagnosed, to start their treatment before their CD4 count falls below 350.  Several  large studies have also shown that people who start treatment with CD4 count of 350 compared to people starting at 500 or above, get similar benefit from treatment.

This is the reason why your doctor recommends that you wait for another test before starting treatment.  CD4 count is used to determine when to start treatment.  A single CD4 count does not mean a lot, you need a several results to know the ‘average line’. Then your doctor can tell whether the trend is going up or down, how quickly it changes and whether it is stable.

CD4 count can fluctuate through the day – lower readings in the morning and higher later in the day.  Diet exercises or having a flu can also can affect the results but none of these variations mean that your immune system is stronger or weaker.  Do ask you doctor about CD4 percentage (CD4%) test.  This will will give you more stable reading, whether there has been a change in the immune system. CD4% is a test that look at the CD4 count in relation to other immune cells.

In general, the biggest risks come when the CD4 count is below 200. Most people are unlikely to have HIV related illness when their CD4 count is over 200.  The risk is even lower when the CD4 count is over 350.

As you have just been diagnosed, it is a good idea to take a little time to come to terms with this before starting treatment. Your viral load is still very low – most people don’t start until this is between 50,000 and 100,000 or higher. Your health will not be at any risk from taking a month or two to see whether your CD4 count is stable or not.

By the way, do you have any support at the moment?  Getting support from your local support group or a counsellor can help you to come to terms living with HIV. Also you will be able to gain and share experiences with others who are in the similar situation as you, rather than having to deal with it in isolation.