Question
My CD4 is 347… do I need to start treatment?
5 December 2009. Related: All topics, CD4 and viral load, Starting treatment.
Hi there
I’d just like to first say this website has been really helpful.
I was recently diagnosed a few weeks ago: my first CD4 count was 312 and viral load was 1500, which I gather is reasonably low. My second CD4 count as of last week was 347.
I’m meeting my doctor to discuss starting medication as my CD4 count is less than 350. But what I don’t understand is, how can my viral count be so low too? I thought it tended to be CD4 low/high viral load, and vice versa. Surely my viral load should be higher, or does this indicate I have been carrying HIV for quite some time?
I ask because I am a bit upset that I will have to start medication so soon after initial diagnosis, as I thought perhaps I’d have a few years before starting treatment (obviously would rather start treatment if it is recommended!).
Should I hold off another month – has my CD4 count just ‘dipped’ following infection..?
Any thoughts appreciated!
Answer
Thanks for your question and the chance to post the answer online.
There are many good reasons for you to monitor you counts every month for a little longer.
- to see whether any changes are happening.
- if you were only infected recently (within the last 6 months), your CD4 count may increase again by iteslf.
- any risk from not starting treatment immediately are very low
- it will give you time to come to terms with being HIV-positive
- it will give to time to consider treatment options in more detail
- there are no real difference from starting treatment a bit higher or lower than 350
- starting treatment at any level above 300 will still get you to over 500, which which is currently used as a guide for reaching ‘normal’ levels.
The decision of when to start has to be individual, based on your own risks and benefits, and how you feel about changing treatment. As long as you have no other symptoms, your CD4 count is currently strong enough for at least couple of months, not to have any long-term impact on your health.
Although generally low CD4 counts are associated with higher viral load and vice versa, there are many situations where this doesn’t always follow, for different reasons. For example, your current CD4 count is still strong. You could be one of the 5% of people whose natural CD4 count is less than 500 – ie that it would have been under 500 before you caught HIV. In this case, the low viral load indicates not just that you are controlling HIV very well, but that it hasn’t affected your normal CD4 levels.
Hi George,
I’m sorry to hear about your recent diagnosis. But it’s good to see your CD4 count is within the normal range for someone who is HIV negative.
Guidelines around the world recommend starting HIV treatment (ART) sooner rather than later, and at any CD4 count. However, as with all treatment decisions, this is individual. You are the person who has to take ART. You can chose when to start and which drugs you use.
Many people start in the same week they are diagnosed, sometimes on the same day. But as long as there is not a medical urgency (such as pregnancy or a very low CD4 count), you can take time.
There’s more info on how soon do you need to start in this Introduction to ART.
Just found out I was positive. My CD4 count is 498 . I found out today . They say I start ARVs immediately . Please advise
Hi Emma,
I’m sorry to hear about your recent diagnosis. But please can you tell us more.
Women around the world have taken HIV drugs safely in pregnancy now for over 20 years. This usually involves taking at least three drugs and is called antiretroviral therapy (ART).
Have you started ART yet? If so, what meds are you taking, and do you know your viral load result. Please also let us know how many weeks you’ve been pregnant.
For more info please see the guide to HIV pregnancy and women’s health.
Hi l just found out am hiv+ my CD4count is 375 will my baby be safe
Hi Brandon.
Fatigue can be due to a lot of things, however it’s good to hear that you’re going to talk to a doctor about your health.
So I plan to talk with adherence support from my doctors office because I’m not missing dosages but now the fatigue is kicking in and I’m just constantly tired even when I sleep 8 hours
Hi Brando J.
Stress won’t be the reason why your viral load has gone from undetectable to 11,000- it just doesn’t work like that. Now this could be a blip, however to know for sure you’re going to need to have another viral load test done. Is this possible? If your viral load is still detectable, this is something that you’ll need to talk to your doctor about as they’ll need to think about changing your medication.
So I went from undetectable to 11000 copies of the virus in my system I haven’t missed my meds but my stress has been very high dealing with my family issues some deaths as well as my living situation my cd4 is at 350-355 but I have my moments where I feel very fatigued can anyone help to who this has happened
Hi Nancy,
Because your CD4 count is under 350 you should keep taking ARVs even after the baby is born. This is because people with CD4 counts of about 350 or below should start treatment- even if they’re not pregnant. Please see our pregnancy FAQs for more info about being HIV+ and pregnant.
Hi I just find out that im HIV + and im pregnant my CD4counts is 347 the Ganae suggested i start ARV’ s will i take them even after the bby i born or i will stop and monitor my CD4 counts?? pls help!!!