Q and A


My CD4 count is very low, will treatment still work?

I recently found out my CD4 count is 4. I feel fine I only started having skin problems recently. I’m starting with ARVs soon but Im afraid they will kill me as I believe my body is not strong enough. Can treatment really work when you have a CD4 count this low?


HI treatment (ART) can work at any CD4 count, even when the count has become very low.

In your case, because your CD4 count is only 4 it is very important that you start ART quickly. This is because your immune system is very weak and you are at risk of developing infections like TB or pneumonia.

ART is very effective, even with very low CD4 counts. After starting treatment your CD4 count should increase to safer levels.

More than 1 in 4 (25-50%) of people with a CD4 count below 50 cells/mm3 when they begin ART get symptoms of IRIS (Immune Reconstitution Inflammatory Syndrome).

IRIS is when the immune system reacts to infections that is was previously too weak to respond to. This can cause infections like TB and CMV to flare up and need treatment. While IRIS can make things a little more complicated, it is usually easy to treat. This article from thebody.com has information on IRIS.

Although it is normal to worry about starting ART it is very important that you don’t delay. The longer you wait to start, the higher the risk of serious HIV-related illnesses.

Please let me know if you have any questions.

This answer was updated in January 2016 from a question first posted on 21 January 2013.


  1. Lisa Thorley

    Hi Prajwal,

    It sounds like you’re doing really well. The fact that you’re undetectable is great.
    When wanting to know how things are going a CD4% is a more stable result, please see here: https://i-base.info/qa/18 From what you’ve said, your’s is fine.

    Sleeping for 5-6hrs a night isn’t ideal for anyone as our bodies need more than this, however this won’t have an impact on your CD4 count, thus immune system.

  2. Prajwal

    Hello Team,

    I was tested HIV positive 6 months ago and MY CD4 count was 241 and CD4% was 12%. I started the ART immediately.

    And today after 6 months of successful ART I’m Undetectable and my CD4 count is 273 and CD4% is 26.53%

    My question here is, should I be taking CD4 count as reference or the CD4 percentage? My CD4 percentage is not matching the CD4 count.

    Also, I have been sleeping only for 5-6 hours a day since few weeks because of office schedule and little stressed out these days. Will the sleep deprivation affect the CD4 count ?

    Warm Regards


Your email address will not be published. Required fields are marked *