Q and A

Question

Can you start treatment with a CD4 count in the normal range?

27 March 2012. Related: CD4 and viral load, Newly diagnosed.

What is the fate of a patient (HIV positive) whose CD4 count is still within the normal range? Is the patient advised to start the ART or not?

Answer

Answer: Li Marhaban

The normal range of CD4 count varies depending on which make of test is used. This is generally between 400 -1600 for 95% of HIV negative people. A small percentage of people will have higher or lower CD4 counts and this will still be normal for them.

Guidelines recommending when to start treatment vary depending on which country you live in.  In general though, since 2015, HIV treatment is recommended for all HIV positive people.

For example, here in the UK, the 2012 guideline recommends that you should start treatment when your CD4 count is about 350.  Some US guidelines recommend starting when the CD4 count drops below 500 and others to start at any CD4 count is the person is ready for treatment.

These differences affect how early people can access treatment in different countries.

Note: This answer was updated because, from 2015, HIV treatment is recommended for all people living with HIV. There is no need to wait until the CD4 count drips to a certain level. 

10 comments

  1. Roy Trevelion •

    Hi, It’s good that you are on ARVs and have never been sick. That sounds like you’ve got Tribuss to work well. Tribuss is widely used in South Africa. Is that where you live? If so, it’s likely you can get Tribuss at the public clinic. You can talk to the clinic about this, and they might give you the same meds but in a pill with a different name. That’s just because it’s made by a different manufacturer. You can also contact the Treatment Action Campaign.

  2. Annonymus •

    I’m HIV+ since 2015 and I am on ARV’s and I’m no longer working since I had a medical aid and that was easy for me to get my medication getting delivered straight to me at my work place and I have been taking tribuss meds and never been sick as I have just tested and got diagnosed that I am HIV+ and my worry is if I go to the public clinics will I be able to get the same meds?

  3. Robin Jakob •

    Hi,
    Without knowing what treatment you are on i’m afraid i can’t tell you wether your symptoms may be side effects or not. You can talk to your clinic or doctor and they can help you work out wether your sweating is caused by your treatment or by something else.

  4. cc •

    I have been on treatment since 2009 but my problem is I sweat at night. I don’t have TB.

  5. Rebecca McDowall •

    Hi Portia,
    Have you only recently been diagnosed? You will need to see a doctor or nurse to be prescribed ARVs, you can’t buy these over the counter in the chemist. This is because there are lots of different options for which ARVs you can use and you need medical advice to know which are best.

    Have you been seen by a clinic since you were diagnosed?

  6. Portia •

    Hi I am HIV positive so I want to know if I can get ARV’s @ the chemist for ma privacy cases??? How will I get them in a chemist?

    Thank u.

  7. Rebecca McDowall •

    Hi Theo,
    It’s important to have your ARVs prescribed by a doctor. There are lots of different ARVs available and it’s important to make sure that you get the best ones for you.

  8. theo •

    I would also like to know if I can buy arvs or must I go to the clinic.

  9. Angelina Namiba •

    Hello Diana
    With a CD4 count of 160 you do need to start taking ARVs. The WHO (World Health Organisation) treatment guidelines recommend starting treatment with a CD4 count of 350 cells. When your CD4 count gets to 200 or below, you are at risk of developing Opportunistic Infections such as PCP, a type of pneumonia, which can develop when your immune system is weak. I can appreciate that it is difficult for you to go to the clinic everytime because you are working. However, in order for you to be able to continue working, you do need to be in good health. ARVs are the only proven way of increasing your CD4 count and maintaining your good health. Unfortunately, you cannot just go into a chemist and get ARVs as they have to be prescribed by a doctor at the clinic.

  10. Diana •

    Dear Li Marhaban

    I’m here in Alexandra in Gauteng Province in SA ,I tested for HIV + and the CD4 count was 160 degree even now I don’t get treatment and I’m working I can’t go every time to the clinic can I go to special doctor for treatment or to the chemist and buy ARV’s

    thanks

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