Question
Should I start treatment in South Africa with a CD4 count of 320?
11 December 2009. Related: Access to treatment, All topics, Living with HIV long-term, Southern Africa, Starting treatment.
My CD4 Count has dropped from 520 to 310 and my viral load has increased from 100,000 to 195,000 within 7 months.
I am asymptomatic and do not show any weakness from HIV. I have had unprotected sex a couple of times during this period. I live in South Africa and am not yet on ARVs.
What could have caused these major changes?
Do you recommend that I should start treatment ASAP?
Answer
Hi
Thanks for your question and for letting us post the answer online.
Firstly, although your results seem to show that HIV is progressing, it would help to have another set of results to confirm this before making any decision about when to start treatment.
If your CD4 percentage (CD4%) has also dropped over the same period, it is likely that the CD4 count changes are real rather than being an example of natural variation.
Also, although the difference in viral load seems very large, this is still within the margin of error (3-times higher or lower) for this type of test.
If these changes are confirmed, then in many countries it would be straight-forward to start treatment. This is because most guidelines now recommend treatment for anyone whose CD4 count drops below 350 cells/mm3. In the UK, a viral load over 100,000 copies/mL is another reason to start treatment.
Because you are in South Africa, this decision also depends on the choices of treatment available. If your only option is to use a combination that includes d4T (stavudine), then monitor carefully for side effects, especially neuropathy or facial fat loss (lipoatrophy). These side effects are two reasons that this particularly drug is now rarely used in the UK.
AZT is probably a better choice than d4T. Abacavir or tenofovir are better still if either of these drugs are available.
Information on each of these HIV meds is linked from this page.
Unprotected sex puts you at risk of other sexually transmitted infections, including reinfection with a different strain of HIV and in theory this may be linked to your latest results, but this could also just be natural HIV progression.
Your results are not unusual and would be a reason to start treatment in most countries.
See also the information in this guide to starting treatment.
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