How does my CD4 count determine my HIV treatment?
What we use to determine whether or not to treat a patient most is the CD4 count. If it's low, the patient definitely needs treatment. If it's high, they don't absolutely need treatment. The usual cutoff for treatment, if there's no symptoms, is a CD4 count of about 35. Below that, we recommend anti-retroviral therapy. Above that, we're happy with watch and wait so long as there are no symptoms of HIV disease and the person is perfectly well. This is the current guidelines. It may change in the future. As drugs get better and better, and less and less toxic, we may recommend treatment for all people with HIV. Which, as an infectious disease physician, that's what I think would be best. But at the moment, the guideline generally is to start therapy before the immune system is majorly destroyed but when it's being affected significantly and that is around about a CD4 count of 35. Most of us do not use the viral load as a guide to when to start therapy but if it's very high, we know we have to watch that patient more carefully because the CD4 count is more likely to fall quickly.
