Carbohydrates give you energy. To get enough of the right types of carbohydrates:
- Eat five to six servings (about 3 cups) of fruits and vegetables each day.
- Choose produce with a variety of colors to get the widest range of nutrients.
- Choose legumes and whole grains, such as brown rice and quinoa. If you do not have a gluten sensitivity whole-wheat flour, oats, and barley may be ok. If you do, stick with brown rice, quinoa, and potato as your starch sources. If you are diabetic or pre-diabetic or have insulin resistance, then most of your carbohydrates should come from vegetables.
- Limit simple sugars, such as candy, cake, cookies, or ice cream.
Fat provides extra energy. To get enough of the right kinds of fat:
- Get 30% of your daily calories from fat.
- Get 10% or more of your daily calories from monounsaturated fats.
Examples: nuts, seeds, avocado, fish, and canola and olive oils
- Get less than 10% of your daily calories from polyunsaturated fats.
Examples: fish, walnuts, flaxseed, and corn, sunflower, soybean, and safflower oil
- Get less than 7% of your daily calories from saturated fats.
Examples: fatty meat, poultry with skin, butter, whole-milk dairy foods, and coconut and palm oils.
Vitamins and minerals regulate your body’s processes. People who are HIV-positive need extra vitamins and minerals to help repair and heal damaged cells. Eat foods high in these vitamins and minerals, which can help boost your immune system:
- Vitamin A and beta-carotene: dark green, yellow, orange, or red vegetables and fruit; liver; whole eggs; milk
- B vitamins: meat, fish, chicken, grains, nuts, white beans, avocados, broccoli, and green leafy vegetables
- Vitamin C: citrus fruits
- Vitamin E: green leafy vegetables, peanuts, and vegetable oils
- Selenium: whole grains, nuts, poultry, fish, eggs, and peanut butter
- Zinc: meat, poultry, fish, beans, peanuts, and milk and other dairy products
Because it is difficult to get enough of all the nutrients you need from foods, your health care provider may recommend a multivitamin/mineral tablet (without extra iron). Check the label to make sure it provides 100% of the recommended daily allowance (RDA). Discuss with your doctor what you’re taking — more is not always better. If you don’t eat at least three servings of high-calcium (green leafy veggies or dairy) foods each day, you might need to add a calcium supplement to your diet. This is becoming controversial however and more research is being done on this topic.
The inflammatory nature of HIV and AIDS puts those who have it at greater risk for infection, kidney failure and certain types of cancer. In addition to the damaging effects of the virus, side effects of some antiretroviral therapies also can predispose those with HIV to other conditions such as metabolic syndrome.
Nutrition is a valuable tool for people with HIV. Whether you have just been diagnosed, show no signs of illness or are in a more challenging stage of HIV, knowing what and how to eat can help keep your body and immune system strong.
- The Tunajali Project
- Demographic characteristics
- Activities Implemented by HBC TUNAJALI Project for the Well-Being of PLWHA
- CD4 Counts of PLWHA
- Contribution of HBC TUNAJALI Project to the Well-being of PLWHA
- Authors’ contributions
- 8 Health Tips for Managing HIV
- How to stay healthy when you’re HIV-positive
- Healthy Lifestyle Choices for People With HIV
- Healthy eating for people living with HIV
Diagnosed with HIV at a low CD4 count
- Key points
- The immune system and HIV
- Starting HIV treatment after diagnosis
- How effective is HIV treatment in people with low CD4 counts?
- Co-infection with TB and IRIS
- Having a diagnosis of AIDS
- What can you do to look after yourself?
- Sexual health
- Mother-to-child transmission
- Related posts:
Eating well can help:
- Minimize symptoms associated with HIV.
- Lessen the side effects of medications.
- Increase your quality of life.
- Improve your resistance to other infections and complications.
Healthy Eating When the Virus Is Under Control
Individual needs should be taken into consideration for those with HIV and AIDS; however, general healthful eating patterns are a good place to start.
- Consume adequate calories throughout the day to maintain a healthy weight. Those with HIV/AIDS may have increased calorie and protein needs compared to those who do not have this condition.
- Add protein to every meal. Protein is important because it is needed to make, repair and maintain cells in the body. It also plays a role in the immune system. Good protein sources include lean meats, poultry, fish, low-fat dairy foods, eggs, beans and lentils.
- Include a variety of vitamin and mineral rich foods. Fruits, vegetables, whole grains, low-fat dairy and lean protein choices contain vitamins and minerals that help the body function. Zinc and vitamin C are used by the immune system and iron and vitamin B12 are essential for healthy blood cells. Including a variety of nutrient-rich foods helps meet these needs.
- Discuss dietary and herbal supplements with your health care team. Ask about new supplements before starting them as some can interact with medications.
- Be vigilant about food safety. Those with HIV/AIDS are more vulnerable to food poisoning because HIV weakens the immune system. Practicing food safety helps decrease your risk of getting sick. Avoid eating raw or undercooked meat, fish and eggs; only consume pasteurized milk or cheese; wash fruits and vegetables and remember to use separate knives and cutting boards for raw meats and produce.
When Eating is a Challenge
Diarrhea, nausea, vomiting, sore mouth and taste changes all are common issues that can develop with HIV and may make eating difficult.
The best therapy for these hurdles is to meet with a registered dietitian nutritionist. An RDN may already be on your health care team but if not, ask your doctor to refer you to one who is familiar with HIV/AIDS. An RDN can help you develop the right nutrition plan to get you through difficult periods.
Review Journal of Rare Diseases Research & Treatment Open Access
CD4 count improvement as result of enhanced wellbeing of HIV/AIDS patients
Alfred Said Sife1, Tumaini Jonas Wapalila2 and Maulilio John Kipanyula3*
1Sokoine National Agricultural Library (SNAL), Sokoine University of Agriculture, P.O. Box 3022 Chuo Kikuu, Morogoro, Tanzania
2Morogoro Regional Commisioner’s Office, Boma Road, P.O. Box 650 Boma Road, Morogoro, Tanzania
3Department of Anatomy Histology and Cell Biology, College of Veterinary and Medical Sciences, Sokoine University of Agriculture, P.O.Box 3016, Morogoro – Tanzania
The CD4 T-cell count is an important laboratory indicator of the immune status in patients with HIV/AIDS. It is used in decision making to determine when antiretroviral therapy and a need of prophylaxis for opportunistic infections should be initiated. This study was carried out to assess the contribution of donor funded projects to the wellbeing of people living with HIV/AIDS as measured by improvement of CD4 count. A total of 120 respondents were randomly selected from Morogoro urban and Kilombero district, Tanzania. Based on panel data, individual observations were made four times across time and there were a total of 480 observations. The home based care TUNAJALI project provided various interventions including medical care and psychological support with the purpose of improving the health status of people living with HIV/AIDS. The effect of home based care TUNAJALI services was the only predictor of health status of people living with HIV/AIDS that was measured as an improvement of CD4 count over time. The average CD4 count before, one year, two years of home based care, and during the study were: 193.86; 258.83 (25.1%); 375.72 (31.2%); 487.57 respectively. A positive relationship was observed between home based care services and well-being. The findings from the present study show that the home based care positively improved the well-being of HIV/AIDS patients in the studied population. Improved wellbeing also improved CD4 count in patients.
The Tunajali Project
|Age in years|
|46 and above||44||36.7|
|No formal education||2||1.7|
|Petty trading and crop production||33||27.5|
|Crop production and self employment||4||3.3|
|Petty and livestock keeping||2||1.7|
|More than 6||20||16.7|
Activities Implemented by HBC TUNAJALI Project for the Well-Being of PLWHA
|Type of support||Frequency||Percent|
|Drugs found in HBC kits||104||86.7|
|Medical support offered||Drugs in HBC kits and transport fare||13||10.8|
|Drugs in HBC kits and referral to hosp||3||2.5|
|Psychological support offered||Home visiting and counseling||45||37.5|
|Home visiting and counseling & access to PLWHA groups||75||62.5|
|Socio-economic support||Linking to other financial institutions||4||3.3|
|Internal saving and lending groups SILC/CODET||51||42.5|
|Improved health status and be able to engage in income generating activities||48||40.0|
CD4 Counts of PLWHA
Contribution of HBC TUNAJALI Project to the Well-being of PLWHA
|CD4 Mean||t||df||Sig. (2tailed)|
|Pair 1||CD4 for the first time since joined HBC TUNAJALI – CD4 one year since joined HBC TUNAJALI||Before- 193||5.688||119||0.000|
|Pair 2||CD4 one year since joined HBC TUNAJALI – CD4 two years since joined HBC TUNAJALI||Before-258||-10.251||119||0.000|
|Pair 3||CD4 two years since joined HBC TUNAJALI – current CD4||Before-375||-9.614||119||0.000|
|HBC TUNAJALI responsible to the Health status||Frequency||Percent|
|Rise of CD4||1||0.8|
|Aware of living positive||4||3.3|
|Rise of CD4 and change from bed ridden||2||1.7|
|Rise of CD4 and aware of living positive||48||40.0|
|Change from bed ridden & aware of living positive||3||2.5|
|Rise of CD4, change from bed ridden and aware of living||62||51.7|
8 Health Tips for Managing HIV
When you’re living with HIV, it’s more important than ever to protect your immune system to maintain overall health. By keeping your body as healthy as possible, it’s much better equipped to fight off viruses and other types of infections, says Kristin Englund, MD, associate staff member of the department of infectious disease at the Cleveland Clinic in Ohio.
People living with HIV need to incorporate healthy habits into their lifestyle. Follow these eight tips for healthy living with HIV:
1. Practice safe sex. This is paramount on the list. Says Dr. Englund, “Practicing safe sex is essential.” Understand how the virus is transmitted to reduce the risk of infecting others. Use condoms not only to avoid the spread of HIV, but also to protect both you and your partner against other sexually transmitted diseases (STDs) and other types of infections.
2. Get tested for other STDs. If you have another STD, also known as sexually transmitted infections, or STIs, you may be more likely to transmit both HIV and your other STD to someone else. STDs can also worsen HIV and make the disease progress more rapidly. And HIV can make STDs more difficult to treat, so you’ll want to address an STD as soon as possible. Getting tested is a must because many STDs don’t cause any symptoms — without testing, you may not even realize you have one.
3. Prevent infections and illnesses. Since HIV makes your immune system less effective, you become more susceptible to every virus, bacteria, and germ you’re exposed to. Wash your hands frequently, and stay away from sick people to stay as healthy as possible. Also stay up-to-date on all of your vaccinations to reduce your risk of preventable illnesses.
4. Follow doctor’s orders about your prescriptions. It’s crucial to take your HIV medication exactly as prescribed by your doctor. Skipping even one day of medication can give the virus an opportunity to become resistant to the drugs, making them ineffective against the virus, says Englund. Be sure to take prescriptions at the same time every day, and always have your medication with you so that if you are away from home, you won’t have to miss a dose.
5. Don’t abuse drugs or alcohol. Alcohol and drug overuse can contribute to feelings of depression. Avoid illegal drugs and take prescription drugs as directed by your doctor to help protect your immune system. Avoiding drug abuse can also help to prevent cognitive (thinking and reasoning) impairment, which is important in minimizing HIV-related dementia.
6. Quit smoking. Giving up cigarettes is beneficial for anyone. Stopping all tobacco use will help you live healthier and feel better, according to Englund, as well as prevent a number of health problems and reduce your risk of serious events like heart attack and stroke.
7. Manage physical and emotional health problems. Depression is common among people with HIV, and the stress associated with having HIV can worsen depression symptoms. What’s more, both stress and depression can worsen physical pain associated with HIV. Keeping stress, depression, and pain under control can help improve your physical and emotional health, making life with HIV easier. See a mental health professional if you feel you’re experiencing depression, and be sure to mention that you’re taking medication for HIV to avoid potential drug interactions between depression and HIV medicines.
8. Exercise mind and body. Physical and mental exercise can keep your mind and body strong. Regular physical exercise, such as walking, biking, running, swimming, or another activity you enjoy, keeps you physically fit and can keep both stress and depression in check. Physical exercise significantly helps the immune system as well. Mental exercise — doing a daily crossword puzzle or playing brain-challenging games — can help maintain your cognitive health. Exercise your memory, concentration, and attention, all of which can be affected by HIV.
The keys to staying healthy with HIV are within your control. Live a healthy lifestyle. Fuel your body with a healthy, nutritious, and balanced diet, and allow it to recharge each night with enough quality sleep. Treat your body well to strengthen it, so that it can defend against illnesses that could threaten your health.
How to stay healthy when you’re HIV-positive
If you are living with HIV, it’s essential that you take extra care of your health as your immune system is extremely vulnerable. This is because HIV reduces the immune system’s ability to protect the body from viruses and bacteria. It’s also common knowledge that the immune system needs good nutrition to function well. So, for individuals living with HIV, it’s even more important to be health-conscious.
Eat nutrient-rich food
First on the list is following a healthy diet, eating a variety of nutrient-rich foods daily so the body gets enough carbohydrate, proteins and fats, as well as important vitamins and minerals.
Dr Jireh Serfontein of My Sexual Health, a clinic in Pretoria, explains that a Mediterranean diet is a great guide in this regard: “It’s well known that people in the Mediterranean eat a diet rich in vegetables, fruit, legumes and grains plus moderate amounts of chicken and fish. They eat little red meat and most fats are unsaturated ones from olive oils and nuts.”
A good diet can be challenging…
Living with HIV means you may find it difficult to follow a good diet. One reason is opportunistic infections. They can cause diarrhoea and/or vomiting and thus impair the body’s ability to absorb important nutrients.
“Candida, an opportunistic infection in the mouth or throat, for instance, can lead to pain when swallowing, and thus prevent an individual from eating properly,” says Dr Serfontein.
Another potential barrier to good nutrition is medication as some of the side effects of antiretrovirals (ARVs) are diarrhoea and vomiting, although they do diminish over time. On the other hand, if the HIV is not treated and the patient gets AIDS, the virus itself causes damage to the intestinal tract. This results in impaired absorption as nutrients are lost through damaged intestinal walls.
Still, it is important to keep focused on getting as much good nutrition into your body as you can, so perserverence is key. Consult your doctor or clinic if you are struggling to find a balance or experiencing any of these setbacks.
HIV can also affect an individual’s health in other ways. The HI-virus causes immune dysfunction, putting the HIV-positive individual at risk of getting other infections like pneumonia, tuberculosis (TB), and meningitis. If you are on ARVs, the risk of these infections is low but it is important to make sure that your immunisations are up to date.
“Ask your doctor for the following: pneumococcus vaccine, hepatitis B vaccine, diphtheria, whooping cough and annual flu vaccines,” says Dr Serfontein. Speak to your Clicks Clinic sister or pharmacist about vaccinations that are available to you and book an appointment for them by visiting Clicks Clinics online.
The other critical health issue regarding living with HIV is the risk of heart attack or stroke, which is much higher in HIV-positive individuals compared with those who are HIV-negative, even if you are on ARVs.
There are several well-known factors that increase the risk of stroke and heart attack. These include hypertension, smoking, diabetes, high cholesterol, being overweight and a lack of physical activity. It’s therefore very important not to smoke and to manage hypertension, diabetes and high cholesterol optimally, if you are HIV positive. This means eating a balanced diet, maintaining a healthy weight (your Body Mass Index, or BMI, needs to be less than 25) and exercising at least three times a week.
Avoid knocking back the alcohol
Alcohol is also potentially dangerous if you are HIV-positive. Some studies have shown that excessive alcohol use has a negative effect on your CD4 count, hastening the disease progression of HIV. It can also contribute to the spread of HIV by impairing one’s judgement which in turn leads to risky sexual behaviour. Additionally, alcohol use can also make it difficult to take ARVs as prescribed.
How Clicks Clinics can help you
Did you know Clicks offers HIV testing and counselling at our clinics? To make an appointment at a Clicks Clinic, call 0860 254 257 or book online at Clicks Clinics online.
HIV home test kits are also available for purchase in-store.
Shop online at Clicks.co.za for condoms
Don’t be caught unawares – rather stock up on condoms via the convenince of online shopping so that you can ensure you’re practising safe sex at all times.
IMAGE CREDIT: 123rf.com
An HIV diagnosis was once a death sentence, but that is no longer the case for those of us who stay healthy. In fact, the average HIV-positive person today is expected to live to be nearly 80, roughly on par with the general population. As more and more people reaching the century mark, here’s a list of the best things you can do — besides adhering to your medication regimen — that’ll help you have a long, healthy life.
1. Keep Your Head in the Game
Depression, stress, and anxiety are tough for people to overcome, but these conditions can also harm your immune system. Psychotherapist Melissa Lopez works with her HIV-positive patients to develop a plan once their moods start to sour. ”When you’re already working with a compromised immune system, pre-depression or anxiety can bring on a lack of motivation,” she says, which can lead to people slacking on their meds. Lopez suggests finding a professional counselor, especially when you’re first diagnosed with HIV, to form a plan to deal with anxiety, depression, or other negative feelings. ‘
‘Know the symptoms of depression, know the symptoms of anxiety, so you know what’s happening to you,” she says. ”You have to be proactive to prevent another, deeper cycle of depression.”
2. Beat Back the Blues
Even when things don’t seem like they’re going your way, looking at things with a positive attitude may be enough to help you get through a tough situation, and even live longer. One study indicated that people in their 20s who used mostly positive, affirmative words to describe themselves were more likely to live into their 80s than those with negative outlooks. Additionally, people with a more positive view of life tend to have fewer strokes, coronary problems, injuries, and colds, and positive-thinking women have healthier pregnancies.
3. Nurture Your Gut
The lymphoid tissues in a person’s stomach are filled with T cells. Because HIV affects T cells, many people with HIV have gastrointestinal problems, but a healthy GI tract is crucial to proper absorption of antiretroviral medication. Some anti-HIV meds need to be taken with food to assure this absorption and avoid potential side effects such as diarrhea. Many HIV-positive folks could also benefit from probiotics and a high-fiber diet, APLA’s expert Brian Risley says.
- last “
Healthy Lifestyle Choices for People With HIV
An HIV diagnosis can turn your whole life upside down. Just as you become alert to HIV symptoms and find yourself faced with a new routine of doctor’s visits and medications, you may also want to make some healthy lifestyle changes that can improve your health and quality of life. Start by:
- Eating a more nutritious diet. This can:
- Help you remain healthier overall despite your HIV infection.
- Slow down the progression of HIV to AIDS.
- Help prevent health problems related to malnutrition.
- Help you maintain a healthy weight and avoid the excess weight loss that can occur in HIV-infected individuals.
A healthy diet for someone living with HIV is one that is rich in whole grains, low fat dairy products, protein, and lots of fresh fruits and vegetables. Include multivitamins, especially B12 and zinc, wherever possible. Remember that a healthy diet is also about what you don’t eat: Try to cut out fried foods and sugary drinks as much as you can.
- Quitting smoking. According to the CDC nearly 18 percent of adults in the United States smoke — that rate is two to three times higher in adults with HIV. Syracuse University researchers analyzed data from 212 adults with HIV and found that people with HIV who smoked also reported having more symptoms such as coughing and dizziness.
- Stopping illicit drug use. If you are using illegal drugs such as cocaine, heroin, or methamphetamines, seek treatment for your addiction. Sharing needles to use such drugs can leave you vulnerable to other infections such as hepatitis, and that may lead to more rapid progression of HIV to AIDS. Illegal drug use could also affect the HIV disease itself. A recent study from the University of Pennsylvania School of Medicine demonstrated a dramatic increase in the ability of HIV to attack healthy cells when methamphetamine is present in the bloodstream. If you do continue to use injectable drugs, do not share needles with others.
- Getting moderate exercise. Being physically active three to six times a week can help improve your mood and your outlook as well as improve your overall quality of life. The benefits of exercise include fighting HIV symptoms of appetite loss and nerve pain, and reducing the risk of other chronic diseases such as diabetes, heart disease, and osteoporosis.
- Practicing safer sex. Having HIV does not mean the end of your sex life — but you should always use a new latex condom whenever you do engage in sex. This will protect your partner from your HIV infection and will protect you from sexually transmitted diseases (STDs) that can complicate your health status.
- Getting tested and treated for sexually transmitted diseases. Many people with HIV also have other STDs, even if they are asymptomatic. Get tested to find out if you have any other infections and get treated if you do.
- Taking your medications as prescribed and visiting your doctor often. Your doctor may have prescribed HIV medications to help your body’s immune system stay healthy longer. Taking those medications as prescribed, even though it may be difficult to keep up with the medication schedule, is extremely important. Taking medications on schedule is called adherence — it is important because it will reduce the risk that HIV will become drug resistant and it will also give your body the best chance at keeping the virus under control.
- Taking steps to prevent infections. If you have HIV, you can get infections more easily. Many of the healthy lifestyle steps above will help you avoid infections — for example, quitting smoking removes a significant contributor to lung infections. There are some other steps you can take to reduce common causes of infection, such as washing your hands well and often, practicing good food safety to avoid foodborne illness, and staying current on recommended vaccines.
Making these changes in your life will help you stay healthier longer, even with HIV.
Healthy eating for people living with HIV
- Make sure your diet is fulfilling all your individual nutritional requirements.
- Give you advice about your diet if you are experiencing metabolic changes due to your HIV treatment.
- Regularly check your body weight and ensure that the proportion of fat to muscle is appropriate.
- Advise you on any dietary changes you may need to make if you become ill.
- Help you avoid food poisoning.
- Offer advice on symptom control, such as how to manage changes in taste caused by medication.
- Give advice for managing conditions such as diabetes, obesity, hyperlipidaemia (high levels of fat in the blood) and poor absorption of food.
- Give advice on your nutritional requirements during pregnancy.
- Help you identify and manage any food allergies and intolerances.
- Advise you on your nutrition needs based on your exercise levels or sporting activity.
- Provide information and advice on the use of vitamins and minerals and complementary therapies.
Some dietitians use a variety of tests to assess how much muscle and fat there is in your body. If these tests are done regularly your dietitian may be able to spot changes in weight and body composition before you do. However, you may be the first to notice changes in your weight or body shape – for instance, if your clothes become too loose or tight. These may be important times to talk to your dietitian about making changes to your diet or exercise.
There’s no specific eating plan for people with HIV, but an overall healthy diet can help your health a lot.
The virus weakens your immune system. Because your body uses nutrients to keep up its defenses against germs, eating well can help you fight off infections. It can also boost your energy, keep you strong, help you avoid health complications, and ease issues brought on by HIV and its treatments.
Follow these simple tips to get started.
1. Eat plenty of fruits and vegetables. They’re high in nutrients called antioxidants, which protect your immune system. Aim to have five to nine servings of produce each day. An easy way to meet that goal is to fill half of your plate with fruits and veggies at each meal. Eat a lot of different produce to get the most vitamins and minerals.
2. Go for lean protein. Your body uses it to build muscle and a strong immune system. Choose healthy options like lean beef, poultry, fish, eggs, beans, and nuts.
You may need to eat more protein if you’re underweight or in a later stage of HIV. Your doctor can help you figure out the right amount for you.
3. Choose whole grains. Like gas in a car, carbs give your body energy.
That makes whole-grain carbs, like brown rice and whole wheat bread, high-end fuel.
They’re packed with energy-boosting B vitamins and fiber. And when you eat plenty of fiber, that can lower your chances of getting fat deposits called lipodystrophy, a potential side effect of HIV.
4. Limit your sugar and salt. Whether because of the virus or the treatment drugs you’re taking, HIV raises your chances of getting heart disease. Too much sugar and salt can harm your ticker. So aim to get less than 10% of your calories each day from foods and drinks with added sugar. You should also have no more than 2,300 milligrams of sodium per day.
5. Have healthy fats in moderation. Fat provides energy, but it’s also high in calories. If you’re not trying to gain weight, limit how much of it you eat. Heart-healthy choices include nuts, vegetable oils, and avocado.
Diagnosed with HIV at a low CD4 count
- A low CD4 count means that HIV has damaged your immune system and may be making you ill.
- HIV treatment will strengthen your immune system and extend your life.
- While your CD4 count is low, you may also need to take antibiotics to prevent infections.
HIV treatment is recommended for everyone who has HIV, but it is especially important for people with a low CD4 count. This indicates that HIV has damaged their immune system to such an extent that they are at risk of serious illnesses.
Every year several thousand people learn that they are HIV-positive when their CD4 count is already below 350 (two in five of all people diagnosed in the UK in 2014). HIV may be making them ill, or they may have another condition associated with HIV.
If you are diagnosed with HIV with a low CD4 count, you will be recommended to start HIV treatment very soon or even straight away. You may need additional treatment and monitoring, but there is a good chance that you will respond well and your immune system will start recovering.
The immune system and HIV
The immune system’s different cells work together to protect the body against pathogens such as viruses and bacteria.
The human immunodeficiency virus (HIV) mainly infects the CD4 cells in the immune system. Over years of HIV infection, CD4 cell numbers usually drop gradually, but constantly, and the immune system is weakened. If nothing is done to slow or halt this destruction, it becomes unable to fight infections and you become ill.
Antiretroviral drugs interrupt this process. The aim of treatment is to reduce levels of HIV (often called your ‘viral load’), so your CD4 count increases and your body’s ability to fight infections improves.
Starting HIV treatment after diagnosis
The sooner you start to take HIV treatment, the sooner you can benefit from it. HIV treatment will strengthen your immune system, reduce the amount of HIV in your body and prevent illnesses from occurring. Effective HIV treatment also helps prevent you from passing HIV on to someone else.
If your CD4 count is below 200 your doctor will recommend starting HIV treatment immediately. You have a risk of developing serious – and potentially life-threatening – illnesses. You may also need to take antibiotics (a treatment called prophylaxis) to prevent you developing opportunistic infections. Once your CD4 count has increased to above 200, you stop taking the prophylaxis. If you are already ill with an infection, you usually will start treatment for this before you start HIV treatment.
How effective is HIV treatment in people with low CD4 counts?
HIV treatment is highly effective. Many people’s CD4 count will start to climb after starting treatment. Long-term HIV therapy can result in your CD4 count returning to the normal level for your age. Once your CD4 count improves, with continued treatment and care, your life expectancy is very good.
Other factors, such as age, viral load, genetic make-up, lifestyle and quality of health care will also affect your future health and life expectancy.
CD4 cell count
A test that measures the number of CD4 cells in the blood, thus reflecting the state of the immune system. The CD4 cell count of a person who does not have HIV can be anything between 500 and 1500. When the CD4 count of an adult falls below 200, there is a high risk of opportunistic infections and serious illnesses.
The body’s mechanisms for fighting infections and eradicating dysfunctional cells.
A disease caused by the bacterium Mycobacterium tuberculosis. There are two forms of TB: latent TB infection and TB disease (active TB). In people with HIV, TB is considered an AIDS-defining condition.
How well something works (in real life conditions). See also ‘efficacy’.
Measurement of the amount of virus in a blood sample, reported as number of HIV RNA copies per milliliter of blood plasma. The VL is an important indicator of HIV progression and of how well treatment is working.
Some people’s CD4 cell counts do not increase, or rise very slowly, even though their viral load is ‘undetectable’. This can mean people are at greater risk of becoming ill and of dying of HIV-related illnesses. They may also be at greater risk of developing heart disease and cancers.
If this is the case, it is very important that you receive careful health monitoring so that any developing health problems can be detected and treated early.
Some research has suggested that the risk of developing health problems is linked to your lowest-ever (or ‘nadir’) CD4 count, even in people whose immune system has recovered well. However, other research has questioned this link.
Co-infection with TB and IRIS
The decision when to start HIV treatment may be more complicated if you have tuberculosis (TB). There are potential interactions between anti-HIV drugs and a key TB treatment. Some doctors recommend delaying treatment with anti-HIV drugs until after two or three months of TB treatment. However, this will depend on many factors, including your CD4 cell count. If your CD4 cell count is below 100, your doctor will recommend you start HIV treatment as soon as is practicable – ideally within two weeks of starting TB treatment.
A risk after starting HIV treatment is that you could develop a condition called immune reconstitution inflammatory syndrome (IRIS). This is where someone, soon after starting HIV treatment, seems to have worsening symptoms of another infection or disease, such as TB. In fact, the illness is thought to be caused by an improvement in the immune system’s ability to respond to infection. Your doctor will make a decision about how best to treat IRIS, but it is likely you will stay on HIV treatment unless you become seriously ill.
Having a diagnosis of AIDS
Acquired immune deficiency syndrome (AIDS) is the name used to describe a range of illnesses (chiefly infections and cancers) which can develop when someone’s immune system has been damaged by HIV.
In the UK, someone will be given an AIDS diagnosis if they develop an AIDS-related illness. Not all AIDS-defining conditions have the same outlook.
Being diagnosed with AIDS does not mean that your health will continue to deteriorate. Many people diagnosed with AIDS have become healthy again, with good treatment and care.
What can you do to look after yourself?
The most important thing is to start HIV treatment, and to take it exactly the way you are advised to (this is often called adherence).
“Once your CD4 count improves, with continued treatment and care, your life expectancy is very good.”
Attend your HIV clinic for regular check-ups. These monitor how your treatment is working, with regular screening for other health problems. Having a good relationship with your healthcare team is important, so that you feel able to be honest about your health, lifestyle, adherence and any other issues, to help you receive the best possible care and support.
Register with a GP (family doctor) for non-HIV-related health problems. GPs can give you an annual flu vaccination (recommended for people with a weakened immune system), and provide advice on lifestyle factors that help keep you well, including healthy eating, exercise and giving up smoking.
While your CD4 count is low (under 200), ensure your drinking water is free from infection and take extra care in preparing and storing food to avoid food poisoning. Be careful to avoid infections if you are handling animals or gardening. Your healthcare team can talk to you about any risks and give you advice.
Taking care of your sexual health to protect yourself and any partner(s) is important. Condoms are a very effective method of preventing HIV transmission. Being on effective HIV treatment (so that your viral load is ‘undetectable’) means that you are much less likely to pass on HIV.
If you are diagnosed with HIV while you are pregnant, it is extremely important you receive the right HIV treatment and care as soon as possible. Even if you are diagnosed late in pregnancy, this can prevent your baby from being infected.