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Is Your HIV Treatment Working? Warning Signs and False Alarms

Last Reviewed: May 29, 2013

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Is My Immune System Recovering Enough?

The Basics: As we just discussed, an effective antiretroviral regimen should suppress replication of HIV. That gives your immune system a break and allows it to recover. When it comes to measuring immune recovery, the conversation revolves around two major markers: your "absolute CD4 cell count" and your "CD4 percentage," or the proportion of your white blood cells that are CD4 cells.


Depending on the person, the pace of your rise in CD4 cells can be amazingly fast, frustratingly slow or somewhere in between. People who begin treatment at a low CD4 cell count (below 200) often have a steeper hill to climb, and depending on how weak their immune system is to begin with, it may take longer to climb it. Other people might see a rise and then a leveling out, then see another rise after a long time on treatment.

The main measure of your health, of course, is whether you get sick any more often (or with more severity) than an HIV-negative person. But we can use CD4 count and CD4 percentage as a way to gauge the likelihood that you'll develop illnesses in the future.

A Tricky Measuring Tool: The problem with obsessing about your CD4 cell count is that it can mislead you. Getting over a cold? Stressed out? Recently vaccinated? Getting your blood drawn at a different time of day than usual? Any of these things and more can influence the number you'll get back from the lab.

Your CD4 percentage is a little more reliable than your CD4 count because, if your absolute number of CD4 cells/mL is down, it's often because the larger pool of white blood cells is also down. This is why knowing the percentage of white blood cells that are CD4 cells can be more useful: It can help distinguish a real change from one that looks like a big deal but isn't.

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Another thing that can complicate setting a specific CD4 number as a goal for HIV treatment is that everybody is different. A "normal" CD4 count for an HIV-negative person can be anywhere between 500 and 1500, and a "normal" CD4 percentage can vary from 30% to 60%.

The Bottom Line: Regardless of the pace or the exact number, you want to see your CD4 cell count go in one direction over time: up. You likely don't know what your normal count was long before you got HIV, and everyone is different, but more CD4 cells (and a higher CD4 percentage) are a good thing. If it seems like your CD4 numbers aren't budging much, or if repeated tests over time show that they're beginning to drop, talk to your health care team about why that might be.

How Am I Feeling?

The Basics: There are few certainties in HIV/AIDS treatment, but one is that you can't tell what your viral load or CD4 count is by how you feel. Only those blood tests you take can tell you for sure. However, how you feel can tell you a lot about a lot.

Every medication in the world has potential side effects and toxicities. Some meds have more side effects than others, and some may be more likely in some people than others. It's important to take note of changes in the way you feel after you start treatment and beyond -- both physically and mentally.

In the Beginning: Many people don't notice much of anything when they start treatment. Others have a minor side effect or two that will dissipate over the first few weeks. Still others have severe side effects that can make daily life harder; they may go away after a few weeks, or (rarely) they may persist.

If you get a new symptom after starting treatment that gets worse or doesn't go away, it's important to bring it to your doctor's attention. There might be blood tests to run to see how your liver or kidneys are doing with the medications and the two of you can hatch a plan forward.

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