Question

How can I feel fine off-meds with a very low CD4 count?

27 May 2013. Related: All topics, CD4 and viral load, Opportunistic infections, Starting treatment.

Hi, my CD4 count is 16 and i was diagnosed HIV in 2006. It has been seven years and I am feeling perfectly fine without any medication. How come?

Answer

Answer: Simon Collins

The short answer to why your current health is okay is that you have just been very lucky. But as everyone in the UK has access to free lifesaving HIV meds and that treatment is now so easy and safe, I am wondering why you are taking such high risks with your health.

Are you worried about treatment? If so, I wondered why. I am very happy to talk thought the advantages and disadvantages if this helps.

The fact that your CD4 count is already so low shows that it is just a matter of time until something very serious happens. It is only luck that it hasn’t happened yet.

But your luck has not protected your CD4 count, so the risks to your health are very real. Your immune system is severely suppressed and you are very vulnerable to a wide range of infections.

For example, is your doctor routinely and regularly examining your eyes?

This should be on a monthly basis. There is a 30% risk for a viral infection called CMV becoming active over three years in someone whose CD4 count is less than 50. Damage from CMV is irreversible sight loss and the treatments for CMV are very difficult.

If is very common for infections in someone with a CD4 count under 50 to be rapidly serious and to require immediate hospital admission. HIV-related deaths in the UK are now mainly related to people who are diagnosed with very low CD4 counts, or in people who are not on treatment.

Are you currently taking the dual antibiotic Septin? This is recommended for anyone whose CD4 count is under 200.

Some people with a low CD4 count can have pretty good health, though there are usually minor problems too. But serious things can happen very quickly.

This was my own experience in the mid-1990s and I was lucky enough to be here where the meds finally came. This is one of the reasons I run an HIV organisation now.