The main risk factor for most HIV-related illnesses is your CD4 count. This increases as the CD4 count drops.<\/p>\n
Generally this risk is low once your CD4 count is over 200 and the risks continue to drop the higher it gets.<\/p>\n
However, the risks, although low, are still significant enough when your count is between 200 and 350 for many treatment guidelines to recommend starting treatment at a CD4 count of around 350.<\/p>\n
Note that this recommendation is for people with access to latest HIV drugs (ie it is not the same if you are starting with a d4T (stavudine)-based combination.<\/p>\n
Three important studies last year also showed that people with CD4 counts over 350 have a low risk of both AIDS-defining and non-AIDS-defining serious illnesses. This risks were lower in people on combination therapy compared to those not on treatment.<\/p>\n
In i-Base material we never say that there is no risk at higher CD4 counts – just that the risk reduces, and that research shows this reduces further by using HIV treatment.<\/p>\n
Providing information involves us striking a balance between the optimistic news that generally with a CD4 count above 200 and even more above 350, the risks are very low (especially if you are on-treatment), with the realistic fact that even at higher counts your risk of some rare events are higher than if you were HIV-negative.<\/p>\n
This table<\/a> shows (from the i-Base training manual<\/a>) the risk of different illnesses by CD4 count, and includes the note that some cancers can occur at any CD4 count.<\/p>\n Recent analysis from the D:A:D cohort, the CASCADE cohort, and the SMART study have shown that some illnesses (including some heart, liver and kidney-related disease, and some cancers), that were not defined as HIV-related, occur at higher CD4 counts, and that this may be related to untreated HIV. I have come across people who are convinced that nothing is going to happen to them if their CD4 count is above 200, (it is a bit similar to a long held belief that no HIV infection could occur from oral sex, when it can).<\/p>\n I feel it would be good to state this clearly somewhere in the i-Base data, it could be very important to an individual who might be in that situation.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,9,29,39],"tags":[],"class_list":["post-739","post","type-post","status-publish","format-standard","hentry","category-all-topics","category-cd4-and-viral-load","category-opportunistic-infections","category-starting-treatment"],"_links":{"self":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/739","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/comments?post=739"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/739\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/media?parent=739"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/categories?post=739"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/tags?post=739"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nI agree with your comment on oral sex. The limited research suggest that perhaps 5% of HIV infections may be due to this. The most important co-factors likely to explain this are i) oral hygiene including bleeding gums etc and ii) viral load of the HIV-positive partner, especially if they are in very early infection.<\/p>\n","protected":false},"excerpt":{"rendered":"