Question
Can I get HIV-related illnesses if my CD4 count is over 200?
5 January 2009. Related: All topics, CD4 and viral load, Opportunistic infections, Starting treatment.
I have come across people who are convinced that nothing is going to happen to them if their CD4 count is above 200, (it is a bit similar to a long held belief that no HIV infection could occur from oral sex, when it can).
I feel it would be good to state this clearly somewhere in the i-Base data, it could be very important to an individual who might be in that situation.
Answer
The main risk factor for most HIV-related illnesses is your CD4 count. This increases as the CD4 count drops.
Generally this risk is low once your CD4 count is over 200 and the risks continue to drop the higher it gets.
However, the risks, although low, are still significant enough when your count is between 200 and 350 for many treatment guidelines to recommend starting treatment at a CD4 count of around 350.
Note that this recommendation is for people with access to latest HIV drugs (ie it is not the same if you are starting with a d4T (stavudine)-based combination.
Three important studies last year also showed that people with CD4 counts over 350 have a low risk of both AIDS-defining and non-AIDS-defining serious illnesses. This risks were lower in people on combination therapy compared to those not on treatment.
In i-Base material we never say that there is no risk at higher CD4 counts – just that the risk reduces, and that research shows this reduces further by using HIV treatment.
Providing information involves us striking a balance between the optimistic news that generally with a CD4 count above 200 and even more above 350, the risks are very low (especially if you are on-treatment), with the realistic fact that even at higher counts your risk of some rare events are higher than if you were HIV-negative.
This table shows (from the i-Base training manual) the risk of different illnesses by CD4 count, and includes the note that some cancers can occur at any CD4 count.
Recent analysis from the D:A:D cohort, the CASCADE cohort, and the SMART study have shown that some illnesses (including some heart, liver and kidney-related disease, and some cancers), that were not defined as HIV-related, occur at higher CD4 counts, and that this may be related to untreated HIV.
I agree with your comment on oral sex. The limited research suggest that perhaps 5% of HIV infections may be due to this. The most important co-factors likely to explain this are i) oral hygiene including bleeding gums etc and ii) viral load of the HIV-positive partner, especially if they are in very early infection.
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