I was wrong! Malawi guidelines treatment below CD4 500

I was wrong! My apologies, dear readers, and thank you to all those that sent emails correcting me. In 2014 Malawi treatment guidelines were revised. Treatment starts at CD4 cell count below 500 cells/mm3 not 350 as published in last week’s column. I have written columns on the challenge of these new guidelines in Malawi — access to CD4 cell counting equipment, availability of drugs for treatment, among others. Somehow, it completely slipped my mind last week. So that is my very poor and unacceptable excuse.

I read the other day that wise and fearless leaders own their mistakes (wink, wink, hint, hint!). I didn’t mean to diminish the hard work of the clinicians, researchers, health workers, caregivers who are at the frontline of providing access to care and treatment of people with HIV.

While we are on the topic of CD4 count, let’s understand CD4 cells and cell counts.

CD4 cells are a type of white blood cells that play a major role in protecting your body from infection. They send signals to activate your body’s immune response when they detect “intruders” like viruses or bacteria.

Once a person is infected with HIV, the virus begins to attack and destroy the CD4 cells of the person’s immune system. HIV uses the machinery of the CD4 cells to multiply (make copies of itself) and spread throughout the body. This process is called the HIV cycle.

CD4 count is a lab test that measures the number of CD4 cells in a sample of your blood. It is an important indicator of how well your immune system is working.

The CD4 count of a healthy adult/adolescent ranges from 500 cells/mm3 to 1,200 cells/mm3.

A very low CD4 count (less than 200 cells/mm3) is one of the ways to determine whether a person living with HIV has progressed to stage 3 infection (Aids).

After you start ART, your HIV care provider will use your CD4 count as one way to check how well your medication is working to monitor the effectiveness of your HIV regimen. Your HIV care provider will also monitor your CD4 count to determine whether it has fallen to a level at which you might be at risk for certain opportunistic infections. In that case, your HIV care provider may prescribe some additional medications to prevent other infections.

Most HIV treatment guidelines recommend that your HIV care provider order a CD4 test every three to six months when you are starting ART to see how well you are responding to treatment. Depending on your health status, your HIV care provider may switch to every six to 12 months once treatment has increased your CD4 levels to higher levels and your viral load is suppressed. If your CD4 count reaches normal levels and your viral load remains suppressed, your HIV care provider may not check your CD4 count unless there is a change in your health or viral load.