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. Roy Trevelion

    Hi Joshua,
    Guidelines in many countries for when to start HIV meds (ART), say you can start at any CD4 count. The START study showed that HIV treatment has important benefits for your health, even if your CD4 count is still high. You can read more here.

  2. Joshua

    When Should I Start HIV Treatment – HIV Medications – HIV Treatment

  3. Roy Trevelion

    Hi Takalani,
    It is very common for someone to still be negative even if they have not been using condoms with someone who is HIV positive. HIV is quite a difficult virus to catch, so your negative result is also related to good luck. You can read more about it here.

  4. Takalani

    Hi My partner and I went to test. My partner tested pos and I neg last week. His CD4 count is 567. My worry is how come I be negative and he is positive. He will get treatment am Happy about that. What do I take. B’cos they’ll say am neg

  5. Lisa Thorley

    Hi King,

    Viral loads should become undetectable within 3 months, though for some people can it can sometimes take up to 6. If you’re viral load has never been undetectable this is something that you need to talk to your doctor about. Though some peoples viral loads may never become undetectable, this is rare.

  6. King

    Hi is it possible for my viral load to remain at 1000+ after taking treatment for 6 years? Thanks

  7. Roy Trevelion

    Hi Lili,

    Yes, that’s what Simon says in reply to this question above.

    Treatment guidelines in many countries now recommend starting treatment at any CD4 count. Starting treatment sooner rather than later reduces the risk of other illnesses. And once viral load is undetectable there is zero risk of transmitting HIV to partners.

    Many people take a bit of time to make sure they are ready to start. This includes checking that taking the meds fits in with your schedule. You can talk to the clinic about how this best suits you.

  8. lili

    am possitive and my cd4 count is 430 can I start treatment now or when please help

  9. Lisa Thorley

    Hi Virginia,

    How are you doing? Have you got someone to talk to?

    Yes you can start treatment straight away. For info about starting meds, please see here:


  10. Virginia

    Hi I discovered that um HIV positive today and my CD4 count is 651…can I start taking treatment or wait ?


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