What is CD4 and why is it important? | Anonymous HIV Test Bangkok, Pattaya, Phuket, Chiang Mai Thailand | PULSE CLINIC - Asia's Leading Sexual Healthcare Network.

What is CD4 and why is it important? | Anonymous HIV Test Bangkok, Pattaya, Phuket, Chiang Mai Thailand


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What is CD4 and why is it important?  | Anonymous HIV Test Bangkok, Pattaya, Phuket, Chiang Mai Thailand

Written by Dr.Love on 16 May 2016, Last medically reviewed by Dr.Deyn on May 26, 2021

Getting tested for HIV is the crucial first step to find out your HIV status so that you can chose the right prevention strategy (such as PrEP, if you're negative) or you can receive treatment early and protect your loved ones from being infected.

What is CD4 and why is it important for HIV treatment

CD4 count and viral load

If someone has received an HIV diagnosis, there are two things they’ll want to know: their CD4 count and their viral load. These values give them and their healthcare provider important information about:

  • the health of their immune system
  • the progression of HIV in their body
  • how their body responds to HIV therapy
  • how the virus itself responds to HIV therapy


What is CD4 count? 

The CD4 count is a test that measures how many CD4 cells you have in your blood. These are a type of white blood cell, called T-cells, that move throughout your body to find and destroy bacteria, viruses, and other invading germs.

Your test results help your doctor know how much damage has been done to your immune system and what's likely to happen next if antiretroviral treatment  (ART) is not initiated. All persons with  HIV should be started on ART regardless of whether the CD4 count is high or low.  The CD4 count should increase in response to effective ART.

Keeping your CD4 count up with an effective ART can hold off symptoms and complications of HIV and help you live longer. In fact, studies have found that patients who adhere to regular treatments can achieve a life span similar to persons who have not been infected with HIV.

Persons with very low CD4 counts may need to take drugs to prevent specific opportunistic infections (OIs) in addition to taking their ART.  Once the CD4 count increases in response to ART, it may be possible to stop taking these OI medications. 


What Does HIV Do to CD4 Cells?

When a person is living with HIV, the virus attacks the CD4 cells in their blood. This process damages CD4 cells and causes the number of them in the body to drop, making it difficult to fight infections.

A normal CD4 count is from 500 to 1,400 cells per cubic millimeter of blood. CD4 counts decrease over time in persons who are not receiving ART. At levels below 200 cells per cubic millimeter, patients become susceptible to a wide variety of OIs, many of which can be fatal.

The test results don't always match how well you're feeling though. Some people can have high CD4 counts and be doing poorly, for other reasons. Others can have low CD4 counts but feel well, with few complications. However, such patients are at risk of becoming very ill if they don’t start HIV treatment.

Anyone who is HIV-positive should take antiretroviral therapy (ART) medications, regardless of their CD4 count and whether or not they have symptoms. When your treatment is working, your CD4 count should stay steady or go up.

If your CD4 count keeps going down over several months despite adhering to ART, it is possible that your virus is developing resistance to the drugs that you are taking. This should be apparent from HIV viral load tests, which your doctor should be doing every few months. In this case, your doctor may want to change your ART drugs.

When a CD4 count is lower than 200 cell/mm3, a person will receive a diagnosis of AIDS. AIDS occurs in stage 3 of HIV. At this stage, the body’s immune system is weak due to the low number of CD4 cells available to fight disease.


What Else Can Affect Your CD4 Count?

Things other than the HIV virus can influence how high or low your CD4 count is, too. such as an infection like

  • the flu
  • pneumonia
  • herpes simplex virus (including cold sores)

can make your CD4 count go down for a while. Your CD4 count will go way down when you're having chemotherapy for cancer.

To get the most accurate and helpful results for your CD4 count, try to:

  • Use the same lab each time.
  • Wait for at least a couple of weeks after you've been sick or gotten a shot before you get a test.


When to Get a Test for CD4 counts?

Right after you're diagnosed, you should get a CD4 count for a "baseline measurement." That gives your doctor something to compare future test results to. It may also indicate the need for drugs to prevent specific OIs in addition to the drugs you are taking for HIV. A viral load test 2 to 8 weeks after you start or change treatment helps your doctor decide how well the ART is working. A CD4 test will indicate whether the immune system is improving in response to ART. Then you should typically get a CD4 test every 3 to 6 months, or as often as your doctor recommends, to see how well your immune system is doing. Persons with low CD4 counts who are taking drugs to prevent specific OIs in addition to their ART may be able to stop these OI drugs as their immune system responds to ART. Persons with CD4 counts above 500 who maintain viral suppression may not need further CD4 testing.

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What is a viral load?

An HIV viral load test measures the number of HIV particles in a milliliter (mL) of blood. These particles are also known as “copies.” The test assesses the progression of HIV in the body. It’s also useful in seeing how well a person’s HIV therapy is controlling HIV in their body.

A high viral load may indicate a recent HIV transmission, or HIV that’s untreated or uncontrolled. Viral loads are generally highest for a period right after contracting HIV. They decrease as the body’s immune system fights against HIV, but then increase again over time as CD4 cells die off. A viral load can include millions of copies per mL of blood, especially when the virus is first contracted.

A low viral load indicates relatively few copies of HIV in the blood. If an HIV treatment plan is effective, a person will be able to maintain a lower viral load.


What’s the relationship between the two?

There’s no direct relationship between CD4 count and viral load. However, in general, a high CD4 count and a low — or undetectable — viral load are desirable. The higher the CD4 count, the healthier the immune system. The lower the viral load, the likelier it is that HIV therapy is working.

When HIV invades healthy CD4 cells, the virus turns them into factories to make new copies of HIV before destroying them. When HIV remains untreated, the CD4 count decreases and the viral load increases.


Why is it important to get tested regularly?

A single CD4 or viral load test result only represents a snapshot in time. It’s important to track both of these and consider trends in test results rather than only looking at individual test results.

Keep in mind that these values may vary for many reasons, even throughout the day. The time of day, any illnesses, and recent vaccinations can all affect CD4 count and viral load. Unless the CD4 count is very low, this fluctuation isn’t usually worrisome.

Regular viral load tests, not CD4 counts, are used to determine the effectiveness of a person’s HIV therapy. When a person begins HIV therapy, a healthcare provider will want to see how well HIV is responding in their body. The goal of HIV therapy is to reduce or suppress the viral load to an undetectable level.


Some people may experience blips. These are temporary, oftentimes small increases in viral load. A healthcare provider will monitor the viral load more closely to see if it returns to an undetectable level without any change in therapy.

Drug resistance

Another reason for regular viral load tests is to monitor any drug resistance to the prescribed HIV therapy. Maintaining a low viral load reduces the risk of developing resistance to the therapy. A healthcare provider can use viral load tests to make necessary changes to a person’s HIV therapy regimen.


Why is HIV therapy so important?

HIV therapy is also called antiretroviral therapy or highly active antiretroviral therapy (HAART). It consists of a combination of antiretroviral drugs. They’re designed to keep the virus from spreading throughout your body by targeting different proteins or mechanisms the virus uses to replicate.

Antiretroviral therapy can make the viral load so low that it can’t be detected by a test. This is called an undetectable viral load. If a person is virally suppressed or has an undetectable viral load, their HIV is under control.

Starting HIV therapy as soon as an HIV diagnosis is received allows a person to live a long, healthy life. Current treatment guidelines from the U.S. Department of Health and Human Services recommend that a person living with HIV begin antiretroviral drugs as soon as possible after diagnosis. This is essential to reducing opportunistic infections and preventing complications from HIV.

Another benefit to getting HIV under control and having an undetectable viral load is that it helps prevent the transmission of HIV to others. This is also known as “treatment as prevention.” According to the Centers for Disease Control and Prevention, people with HIV who take their prescribed medications and maintain an undetectable viral load have “effectively no risk” of transmitting HIV to people without it.


What’s the outlook for people with HIV?

No matter the stage of HIV, there are advantages to keeping track of these numbers. HIV treatment has come a long way in recent years. Following a recommended treatment plan and leading a healthy lifestyle can help a person keep their CD4 count high and their viral load low.

Early treatment and effective monitoring can help a person manage their condition, reduce their risk of complications, and live a long and healthy life.



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