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. sifiso

    Good morning
    Im excited to say I got a job offer on the company I always wanted to work for but I’m due to a medical examination before I can start work on the 1st of march and now I’m panicking because I’m on atroiza for a year now, does the drug appear on the urine test ,would I need a prescription from my doctor reason I’m asking is I don’t feel like disclosing my status to my new employer.

  2. Roy Trevelion

    Hi Zamile,

    It’s good that you are on treatment. But your CD4 count does look low. Getting the right meds to make sure you get undetectable can help to increase CD4 count. What meds are you taking? Have you been on them for long?

    Spirulina is a kind of seaweed and it can contain quite few vitamins. But there are some vitamin supplements that can affect the levels of HIV drugs in your body. But these are all manufactured. Is the spirulina you’re taking a natural food?

  3. zamile

    my cd 4 is becoming very low but m on treatment it below 20 can i mix spirolina with arvs

  4. Lisa Thorley

    Hi Sifiso,

    Your child won’t be at risk, so they do not need any form of medication. Are you on meds?

  5. Sifiso

    Good day
    This forum really helped me after I thought the was no hope and I thank you.
    I have a question that raises concern, I used a razor blade for shaving last night and I thorough it away and my 3 year old managed to find it in the rubbish bin and slightly cut himself.
    Now it raises concerns
    1.how long can this virus live on an environment (razor blade) without the warmth of the body
    2.Must I get prevention pills for my son(this happened sound 30 min ago) or I must just stop being paranoid
    Please help

  6. Lisa Thorley

    Hi Johndoe,

    This could be related to the HIV, it could however be something non related. Therefore, you should talk to a doctor about this. Also is there any reason why you haven’t started meds?

  7. JohnDoe

    please is burning sensation in the feet 3 months after infection related? Haven’t started treatment yet.

  8. Lisa Thorley

    Hi Sifiso,

    The pill should have already been absorbed by your body. Are you sure that you saw it?
    How you took your meds is OK.

  9. sifiso

    Morning Lisa
    This morning at 04:00am I vomited. I know it was the Mc donald burger that I ate last night, they never sit well the whole night on my stomach,long story short the pill came out and II panicked and took another one immediately. I take my ART at 21:00 wont it be an overdose if i take it as normal tonight?

  10. Lisa Thorley

    Hi Sifiso,

    It sounds like it going OK. Please do let us know when you get your viral load results.


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