The Body: The Complete HIV/AIDS Resource Follow Us Follow Us on Facebook Follow Us on Twitter 
Professionals >> Visit The Body PROThe Body en Espanol


Do CD4 Counts Matter After Starting Treatment? An HIV Doc Responds

May 26, 2016

Joel Gallant, M.D., M.P.H.

Joel Gallant, M.D., M.P.H.

One of the main goals of HIV treatment is to get your viral load below 50 copies/mL where it is considered "undetectable." But what about your CD4 count? Currently, all of the five major international HIV treatment guidelines recommend starting treatment for all individuals living with HIV, regardless of CD4 count. But does CD4 count matter after you start treatment? Why do we continue to monitor CD4 counts if they're not as important as viral loads?

On his personal Tumblr, Joel Gallant, M.D., M.P.H., an HIV doctor at Southwest CARE Center in Santa Fe, New Mexico, answers questions from people living with HIV who are concerned about a number of issues, including starting treatment and CD4 counts.

On May 8, 2016, an anonymous user asked:

I know you and others say to ignore CD4 count, once on meds. However, I'm not quite sure why being undetectable changes why CD4 count is not important. I began meds four months ago and my CD4 count and percentage have not changed from 500 and 21%. I know some see their [numbers] begin to jump right away, while others don't. I also know someone with 900 isn't necessarily better off than someone with 300. I've always read 21% is on the edge of having a fairly functioning system. Why does being undetectable change that, besides not making it worse?

Gallant answered:

We don't pay attention to CD4 counts when you're on therapy because there's nothing you can do with the results. Unless the count is low enough to require opportunistic infection prophylaxis, you can only control your viral load, keeping it undetectable. Beyond that, you have no control over your CD4 count, and there are no interventions you would make based on the number.

In your own case, you're worried about why your normal CD4 count is not higher. But a normal count is a normal count. There's no evidence that 900 is healthier than 500.

So there you have it -- although CD4 counts can be meaningful, there's not much you can do to change them. What do you think? Do you closely monitor your CD4 counts and, if so, why? Discuss in the comments section below.

Joel Gallant, M.D., M.P.H., is the associate medical director of specialty services at Southwest CARE Center in New Mexico. You can ask him a question directly on his Tumblr page, Ask Dr. Joel.

Warren Tong is the senior science editor for and Follow Warren on Twitter: @WarrenAtTheBody.

Copyright © 2016 Remedy Health Media, LLC. All rights reserved.

More From This Resource Center

10 Questions to Ask Yourself Before You Begin HIV Treatment

Are Your HIV Meds Working? Warning Signs and False Alarms

Related Stories

What People Living With HIV Are Saying About Not Coming in for Care
Understanding CD4 Cells and CD4 Cell Tests
More on CD4 (T-Cell) Tests

This article was provided by TheBody.

No comments have been made.

Add Your Comment:
(Please note: Your name and comment will be public, and may even show up in
Internet search results. Be careful when providing personal information! Before
adding your comment, please read's Comment Policy.)

Your Name:

Your Location:

(ex: San Francisco, CA)

Your Comment:

Characters remaining:


The content on this page is free of advertiser influence and was produced by our editorial team. See our advertising policy.