Q and A


Can I start treatment with a high CD4 count?

I HIV positive and thinking of starting treatment.

My CD4 cell count is still high (above 500), but I have heard that you can start treatment earlier if you want to.

Can I start treatment early, and what are the advantages and disadvantages?



UK guidelines recommend that everybody can start treatmentat any CD4 count. This includes CD4 counts that are higher than 500.

Similar recommendation are included in the US and WHO guidelines.

A few countries only recommend ART after the CD4 count drops to below 500. So the guidelines for your country will be important.

Advantages ofr starting above 500 incude:

  • Keeping a high CD4 count.
  • Reducing the risk of other illnesses. This includes both HIV and non-HIV complications.
  • Reducing the risk of transmitting HIV to your sexual partners.

These potential benefits outweight the potential disadvantages.

Disadvantages include:

  • The risk of side effects. But this risk is low and even if side effects occur they are usually mild.
  • Changing your life to make sure you take your meds on time. Many combinations only involve one pill a day.
  • A small risk of drug resistance if your treatment doesn’t work.

The START study provided much of the evidence on the benefits of earlier treatment.

There are some situations where treatment is strongly recommended at higher CD4 counts.

  • If you are coinfected with Hepatitis B or C you would be recommended to start treatment if your CD4 count was less than 500.
  • If you presented with an ‘AIDS defining illness’ (such as Kaposi Sarcoma) you would be recommended to start treatment regardless of your CD4.
  • Starting treatment for people in the UK who are worried about transmitting HIV to their partners. This is because of evidence that shows that ART dramatically reduces the risk of transmission.

The i-Base Introduction to ART answers many questions about starting treatment.

 This answer has been updated several times from a question first answered in October 2011.


  1. Lisa Thorley

    Hi Beaty,

    If you’re planning on having a child, you’re going to need to take ARVs. Please see Q6 here: http://i-base.info/qa/what-are-the-most-asked-questions And yes, this is even if your CD4 count is high.
    You’ve said that your viral load is low, what do you mean by this? Are you an elite controller?

  2. Beaty

    Hi my Cd4 count is 800 and my virul load is low and my partner is negative and he wants a child now and I’m not on treatments I’ve been positive since 2014


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