Can CD4 counts get better with ART?

Question

Hello doctor,

My uncle, who is HIV-positive, started ART two months ago. The doctor said his CD4 count was 180. Is that considered too low? He has to repeat the test next month. What does this number mean, and how does it relate to his immunity? Can CD4 counts improve with medications, and if so, how fast should we expect to see progress? Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern. Here is a breakdown of what his CD4 count means and what to expect regarding his health:

Understanding CD4 count -

CD4 cells: These are a type of white blood cell that plays a crucial role in the immune system by helping the body fight infections. A normal CD4 (cluster of differentiation) count typically ranges from 500 to 1,500 cells per microliter of blood.
180 CD4 cells: A count of 180 is considered low and suggests a weakened immune system. This puts him at higher risk for infections and other complications associated with HIV (human immunodeficiency virus).

Relation to immunity -

Low CD4 count: It indicates a compromised immune system. Patients with CD4 counts below 200 are at increased risk of developing opportunistic infections, which are infections that typically occur only in people with weakened immune systems.
ART (antiretroviral therapy): ART aims to reduce the viral load (amount of HIV in the blood) and increase the CD4 count over time, improving the immune response. The goal is to normalize the CD4 count, ideally above 500, which restores most immune functions to a near-normal state.

Improvement with ART -

How fast can CD4 counts improve: Typically, within the first three to six months of starting ART, patients often see an increase in their CD4 count, usually by 50 to 100 cells per microliter per year. The rate of improvement varies depending on factors like the starting CD4 count, the patient’s general health, and how well they adhere to the ART regimen.
Expected progress: Within the first few months, a noticeable increase in CD4 count is common, but it might take years to reach a normal range.
Monitoring: Repeat CD4 counts every three to six months initially to track progress. Additional tests, like viral load monitoring, will be performed to ensure the HIV is under control.

Significance of repeating the test -

Next month’s test: His doctor likely wants to see if ART is effectively boosting his CD4 count. A continued low CD4 count could indicate the need for an adjusted treatment regimen or additional medical interventions.
Continued monitoring: Consistent follow-up is essential to assess his immune recovery and adjust therapy if necessary.

Emotional Support - Understanding that CD4 count improvement is gradual can help manage expectations. Support from healthcare providers, family, and possibly a counselor can aid in coping with his diagnosis and treatment.

I hope this helps.

Thank you.