Question
Do I need to start treatment?
16 June 2010. Related: All topics, CD4 and viral load, Starting treatment.
I was diagnosed HIV positive in March 2009 with a CD4 count of 720, and a viral load of 84,000. The doctor said that I did not need treatment at the time. But today now my CD4 count is 130 and the viral load is undetectable. Should I start treatment with this CD4 count and undectable viral load or should I get a second opinion and repeat both tests at another diagnostic centre?
Answer
Hello
Thank you for your question.
Looking at your most recent results especially the CD4 count, you would need to be on treatment. The current global treatment guidelines indicate that people living with HIV should start treatment when they get to a CD4 count of 350.
As your CD4 count is now under 200, it is important to start treatment. It is the low CD4 count that puts you at risk of being ill.
Knowing that the most important function of treatment is to suppress your viral load to undetectable levels, your most current viral load results (if true) suggest that you are already achieving this.
You could also ask for your CD4 percentage results from your current clinic. The results of the CD4 percentage may give additional information on how you are doing. If you can afford it, going to another diagnostic centre and having both the CD4 count and viral load tests done would confirm if these are accurate results.
Unfortunately when to start treatment is not a law but it is a recommended policy. Each country has a different policy. The World Health Organisation recommend starting at a CD4 count of 350 but some countries are still starting treatment at 250. You should talk to your doctors and explain that you would like to start medication soon. If they do not agree is there any chance you can change clinics?
If you are in South Africa, you should talk to TAC (Treatment Advocacy Campaign) about this and they should be able to help you. You can find their contact details by following this link
I am worried about the advice we getting from our clinics. The law has suggested that we have to get treatment when we have a CD4 count of 350 but they don`t give us or advice us to start treatment. They often keep saying that we are still ok with a CD4 count of 256.
Please that must be a law as it has been approved to have treatment when we have a CD4 count of 350. I have a CD4 count of 256 and have been encouraged not to start treatment.