Question:
My sister is HIV positive and has been on ARVs for a long time. She disappeared for more than six months.
When she returned and went back for treatment, doctors checked her viral load and found it was high. However, she looks well.
She was counselled and restarted on ARVs. A friend later told me doctors should have checked her CD4 count before restarting treatment.
What is the use of doing a CD4 count on someone who is already on ARVs?
— Liz
Answer:
Dear Liz, a CD4 count is an important test for people living with HIV, including those already on ARVs.
The test measures how much HIV has weakened the immune system. The immune system protects the body from infections and disease-causing organisms.
A viral load test is different. It measures the amount of HIV in a person’s blood.
A high viral load means the virus is actively multiplying. A low or undetectable viral load usually shows that treatment is working well.
Why CD4 Count Is Important
A CD4 count helps health workers know whether a person has advanced HIV disease.
When the CD4 count falls below 200 cells per cubic millimetre of blood, the person is considered to have advanced HIV disease.
A healthy adult usually has a CD4 count ranging from about 500 to 1,500 cells per cubic millimetre of blood.
A very low CD4 count means the immune system has been badly damaged. This puts the person at higher risk of serious opportunistic infections.
These infections are commonly associated with Acquired Immuno Deficiency Syndrome, or AIDS.
Why Returning Patients Need CD4 Testing
People who are newly diagnosed with HIV should have a CD4 count test.
The same applies to people who return to care after interrupting treatment, like your sister.
Even when someone looks healthy, the immune system may still be weak. Physical appearance alone cannot show whether the person has advanced HIV disease.
That is why a CD4 count remains useful.
It helps doctors know whether the patient needs extra screening, closer follow-up or preventive treatment against serious infections.
Many AIDS-related deaths occur among people living with HIV who have advanced HIV disease.
Such patients may also have high viral loads, which increases the risk of transmitting HIV if they are not virally suppressed.
Screening for Opportunistic Infections
People with advanced HIV disease should be screened for serious opportunistic infections.
These include tuberculosis, which remains a major cause of death among people living with HIV.
They may also need screening for infections such as fungal meningitis.
Early screening helps health workers detect dangerous infections before they become severe.
It also allows treatment or prevention to begin early.
Why ARV Adherence Matters
Your sister did the right thing by returning to care.
Counselling and restarting ARVs are important steps after treatment interruption.
However, she should continue regular clinic visits and follow the advice of her health workers.
She should also take her ARVs consistently.
Good adherence helps reduce the viral load, protects the immune system and lowers the risk of HIV-related illness.
In short, a CD4 count is still useful for someone on ARVs, especially after missing treatment for several months.
It helps doctors assess immune damage and identify patients who need extra care.
Editor’s Note:
The source draft ends before completing the final medical recommendation after screening. A qualified HIV clinician should complete that section before publication.