How do you increase your CD4 count?
You can increase your CD4 count by undergoing antiretroviral therapy (ART), which is the treatment for HIV (human immunodeficiency virus).
CD4 cells are white blood cells that help your immune system fight infections. HIV weakens the body’s defenses against disease by destroying these immune system cells.
Antiretroviral therapy is a treatment regimen that involves taking a combination of medicines every day that work together to block HIV from producing more viral cells, thus minimizing your viral load. As the drugs lower HIV levels in the body and fewer viral cells are around to attack CD4, more CD4 cells can survive and continue fighting infections. Without the destruction inflicted by HIV cells, the immune system has time to heal and produce new CD4 cells.
Your CD4 count should begin to rise soon after ART treatment begins.
During the first three months of receiving antiretroviral therapy, most patients will see their CD4 count increase rapidly.
With each year of treatment, the number of CD4 cells tends to increase by 50 to 150 cells per cubic millimeter (mm3) of blood.
CD4 counts will often continue to improve for over a decade with consistent treatment.
When CD4 counts don't increase
For a minority of patients, antiretroviral therapy may not boost CD4 counts as expected, but there are ways to increase the likelihood of success.
Timing is one of the most important factors. Starting treatment as soon as possible after diagnosis, when one’s CD4 count has not yet been decimated, is associated with much better outcomes. If CD4 levels are already low (less than 200 cells per mm3 of blood) when treatment is initiated, the drugs may struggle to generate a meaningful increase. Treatment may fail to boost CD4 counts to a healthy level in about 15 to 20% of those who have a very low number of CD4 cells from the start.
If CD4 levels remain low despite treatment, your doctor will likely consider what factors may be to blame, including certain medications, untreated infections or other conditions. Still, antiretroviral therapy is the best and only proven way to increase your CD4 count.
Symptoms of low CD4 count
A low CD4 count by itself does not cause specific symptoms, but it makes people with HIV highly vulnerable to developing an opportunistic infection, which is the name for infections caused by pathogens that often take advantage of people with weak immune systems. Without adequate levels of CD4 cells, the body has a difficult time fighting off infections. These infections do not normally strike people with a healthy immune system. Instead, they target those with weakened immunity due to HIV or other factors.
There are many different types of opportunistic infections. Below are some of the most common types and their accompanying symptoms:
- Tongue changes (white patches, redness)
- Mouth pain
- Taste changes
- Poor appetite
- Vaginal yeast infections
- Herpes simplex virus
- Sores on the mouth, genitals or around the anus
- Vision changes
What causes low CD4 count?
Once in the body, HIV seeks out and attaches to CD4 cells. Then, the virus alters the genetic material within the infected cell, turning it into an HIV-producing factory that makes and releases new copies of the virus.
HIV-infected CD4 cells are damaged and faulty. Many of these cells die early. As more copies of the virus are created, more CD4 cells are destroyed, and the immune system is left with few CD4 cells to rely on. Without enough CD4 cells, immune system defenses are severely weakened, and the body becomes vulnerable to infections.
What treatment would be given for a low CD4 count?
A low CD4 count can be improved by treating the underlying problem. Anyone with HIV, including those with a low CD4 count, is treated with antiretroviral therapy, or ART.
Antiretroviral therapy involves a combination of different medicines, called antiretrovirals, or ARVs. By preventing the virus from replicating, these drugs reduce the HIV levels in the body (viral load). As the viral load decreases, more CD4 cells can survive.
There are seven types or “classes” of HIV medicines that work in slightly different ways:
- Nucleoside reverse transcriptase inhibitors (NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Integrase strand transfer inhibitors (INSTIs)
- Protease inhibitors (PIs)
- CCR5 antagonists
- Fusion inhibitors
- Post-attachment inhibitors
An antiretroviral therapy regimen often includes three drugs, and at least one of the drugs is usually from a different class than the others. Combining drugs with varying mechanisms increases the efficacy of the treatment and prevents the virus from developing a resistance to the medicines.
HIV treatment is lifelong, and the key to treatment success is consistency. Starting antiretroviral therapy as early as possible, taking the medications daily, and visiting a doctor regularly helps ensure that the virus is kept at bay. CD4 cell counts can only improve if the viral load is suppressed.
- National Institutes of Health (HIV.gov). HIV Treatment: The Basics. August 16, 2021. Available at: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-basics. [Accessed January 21, 2022].
- National Institutes of Health (HIV.gov). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. June 3, 2021. Available at: https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/poor-cd4-cell-recovery-and-persistent-inflammation-despite. [Accessed January 21, 2022].
- Goldschmidt RH, Chu C, Dong BJ. Initial Management of Patients with HIV Infection. Am Fam Physician. 2016;94(9):708-716. https://pubmed.ncbi.nlm.nih.gov/27929247/.
- Herout S, Mandorfer M, Breitenecker F, et al. Impact of Early Initiation of Antiretroviral Therapy in Patients with Acute HIV Infection in Vienna, Austria. PLoS One. 2016;11(4):e0152910. Published 2016 Apr 11. doi: 10.1371/journal.pone.0152910.
- National Institutes of Health (HIV.gov). What Are Opportunistic Infections? January 14, 2021. Available at: https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/opportunistic-infections. [Accessed January 21, 2022].
- U.S. Department of Veterans Affairs. HIV-Related Infections and Cancers: Entire Lesson. Available at: https://www.hiv.va.gov/patient/diagnosis/infections-cancers-single-page.asp. [Accessed January 21, 2022].
- U.S. Department of Veterans Affairs. HIV: Basics. Available at: https://www.hiv.va.gov/patient/basics/. [Accessed January 21, 2022].
- U.S. Department of Veterans Affairs. Treatment Decisions for HIV. Available at: https://www.hiv.va.gov/patient/treat/decisions-single-page.asp. [Accessed January 21, 2022].
- National Institutes of Health (HIV.gov). Drug Class. Available at: https://clinicalinfo.hiv.gov/en/glossary/drug-class [Accessed January 24, 2022]
- National Institutes of Health (HIV.gov). HIV Treatment: Adherence. August 11, 2021. Available at: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-adherence. [Accessed January 21, 2022].
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