Dear Doctor, I have been on ARVs for the last three years, having started taking the drugs when my CD4 count was very low (at 80 cells/ml). When my CD4 count was checked six months after beginning the drugs, it had risen to 190 cells/ml and that is the highest it has ever been.
Last year, I developed TB, which was treated. Recently, the doctor told me I had developed diabetes, which is being treated. I feel well, but I am concerned about my low CD4 count. When my viral load was checked, it was undetectable.
Should I be put on second line drugs, to boost my CD4 count?
The goal of anti-retroviral therapy is to suppress the viral load or activity if the virus in the blood in order to allow the immune system to recover. This has been achieved, because your viral load is maximally suppressed. Therefore, you do not need to be put on second line drugs because the ones you are on are doing a good job.
Your poor immunological response, evidenced by low CD4 counts, could be attributed to the fact that you started taking ARVs late after living with the disease for long and damage had been done to your immune system by HIV.
Because of your low CD4 count, you are “within the range” of being attacked by opportunistic infections. No wonder you have had TB while on antiretroviral therapy.
You should, therefore, continue taking your drugs with good adherence. Make sure you protect yourself from being attacked by opportunistic infections by sleeping under an insecticide treated mosquito net and taking Septrin prophylaxis.
Also, make sure you drink safe water and live in a clean and health environment. You should also have a balanced diet and exercise regularly.
Your experience underlines the importance of all people seeking to know their HIV status and all those, who are HIV- positive to seek care and treatment early even if they are not sick.
Early treatment with ARVs tends to lead to better outcomes, so that we do not continue losing people living with HIV to AIDS.