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 Dreez,

    If the meds that you’re taking contain efavirenz, then yes, bad dreams are a common side effect when you first start them. They should do within a week or two. For more info please see Q 3 here:


  2. Dreez

    I have same bad dreams the first days of taking ARV during the night. Are these one of the side effects?

  3. Simon Collins

    Hi Ashok, I am sorry for missing your comment and not replying earlier. There definitely is treatment in Nepal. This will keep you health for many years. Modern treatment means that life expectancy for HIV positive people is now very similar to HIV negative people. Please talk to your docto about this and let me know if you have other questions.

  4. Ashok

    I am from nepal. Tested HIV positive within three month of possible exposure. Is there haart treatment in nepal? If ART is used when cd4 count goes down below 500, how long can I expect to live?

  5. Roy Trevelion

    UK guidelines recommend starting ARVs at any CD4 count. A CD4 count of 1480 is high. The normal range is between 400 and 1600.

    You can find out more information about starting treatment here:

  6. Ma

    Hi, My CD4 is 1480. Can I start to take ARV?

  7. Robin Jakob


    A CD4 count of 416 is strong.

    The decision about wether or not to start can depend on a number of things. You have time to think through your options and prepare yourself to start treatment. You can find more information about this here

    Atripla is a very widely used and effective medication. In the UK it is recommended as a treatment for people taking ARVs for the first time.

  8. Nono

    My CD4 count is 416.
    is it advisable to start treatment.
    My doctor prescribed atripla is good to start on it.

  9. Rebecca McDowall

    Hi Mtombi,
    It is fine to start treatment with a CD4 count of 480. In some countries treatment is recommended at any CD4 count, or for everybody who has a CD4 under 500.

    Was there a reason you started with a higher CD4 count?

  10. mtombi

    I have started taking treatement when my CD4 was 480 is it owk or I’m damaging my health some how?


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