Checking your health while living with HIV
After a diagnosis, it is standard practice for doctors to ask for a health check every three (3) months. The frequency of tests and examinations may increase if there are other infections (eg. tuberculosis – TB, hepatitis or sexually transmitted infections, etc) or medical conditions (eg. liver or kidney disease) that need to be addressed.
The health checks routinely assess viral load (the amount of HIV in the blood) and CD4 (a white-blood cell indicator that can help us understand how well our bodies fight disease). These life-saving tests are very important in the long-term. Typically, your doctors should also ask for additional medical tests to monitor the health of our body systems and organs (eg. blood composition, liver and kidney function). These types of test are usually included in annual medical checks.
The results of all these tests, along with the advice of doctors, help you make decisions about your choice of HIV treatment and medication. They also help track the efficacy of treatment and identify any possible side effects or damage to the body’s organs.
Everyone is encouraged to have an in-depth discussion with our doctors about these tests, treatments and medications. We need to all feel confident in asking our healthcare providers as many questions as possible. An open communication with our doctors and other healthcare providers is extremely important. This will also enable discussion about other areas of our health. Everyone should try to honestly communicate how are we are feeling – both physically and emotionally, in the same way that every doctor is expected to give us the facts, and stay well-informed with current HIV science, without judgement or prejudice.
CD4 is a type of white blood cell that helps fight infection. CD4 test results are reported either in counts (ranging from 1 to >1000) or as a percentage (%), or both.
CD4 counts can fluctuate from day-to-day (sometimes between 50-100) depending on an individual’s rate of metabolism. Many researchers and physicians state that to reporting acknowledge CD4 in percentage formis a more accurate measure of immune function. A person’s combined CD4 count and percentage test result may need to be specifically requested in some healthcare settings.
A CD4 test measures the CD4 cells per cubic millimeter (mm3) of blood. The typical CD4 range of a person not living with HIV is between 500 to 1600/mm3 (CD4 count) or more than 29% (CD4 percentage).
A test result of a person living with HIV (PLHIV) with CD4 count around 500 (approximately 20%) reflects the wear and tear on the immune system, but is generally no cause for panic. This result signals the need for on-going monitoring and discussion with our doctors. If a CD4 test result is below 500 (less than 20%), this indicates that ARV treatment should be started (or restarted/adjusted if ARV treatment has already commenced).
Recent research indicates that there is a greater chance of a person maintaining higher CD4 levels if they start ARV treatment before their CD4 counts drops below 350 cells/mm3. Everyone should discuss this with their doctors and the appropriate course of action for each individual should be mutually agreed between doctor and patient.
What makes HIV so dangerous is that it breaks into these CD4 cells, takes over cellular operations and multiplies rapidly, thus killing the cells. If HIV progresses without treatment, fewer “infection-fighting” CD4 cells remain available to fight infections in the body, leaving us vulnerable to opportunistic infections (OI), like PCP pneumonia. Therefore it is important that we go for CD4 tests regularly, ideally once every three months, usually done with viral load tests depending on the healthcare setting.
Everyone should be aware that a number of factors can skew CD4 test results (eg. metabolism, stress, exercise, etc). So ideally, blood tests should be drawn at the same time of day and using the same lab for every test. If the result is significantly unexpected, a retest may be requested after two to three weeks.
If someone has taken an ARV “holiday” (ie. a scheduled break in a person’s daily ARV regimen after long periods of treatment) or the regimen has recently changed, monthly CD4 and viral load tests may be requested.
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Measuring viral load
Viral load (VL) tells us is how much HIV is in our blood. Since HIV is a virus, VL is reported in medical tests as the number of “copies of HIV” per milliliter (mL) of blood.
Viral load is highest in the blood within the first 6-12 month to three years after initial infection, after which VL stabilizes or fluctuates depending on the state of the body’s immune system and consistency of HIV treatment.
HIV is still in our bodies even if a blood test show an undetectable viral load. “Undetectable viral load” is a test result typically achieved with consistent treatment and regular doses of antiretroviral medication (ARVs). This result means that the small amounts of HIV in our blood can only be measured using additional testing protocols.
Research says that an undetectable viral load significantly reduces the risk of passing on HIV. However, even with undetectable viral load in our blood, it is possible to have more HIV in other body fluids such as semen, vaginal fluids and the fluid (mucus) lining of the rectum and anus. This presents potential risk of transmitting HIV to our partners so precautions should be taken (eg. using condoms for anal sex, keeping teeth and gums healthy, taking ARV treatment consistently, choosing to take pre-exposure prophylaxis – PrEP - if available, etc).
Hence everyone is encouraged to perform risk reduction strategies (eg. using condoms with water-based or silicone-based lubricant, PreP, oral health, etc) to help keep ourselves and others healthy.
Acknowledgement: This Information has been adapted from the “Next Steps” booklet by the Australian Federation of AIDS Organisations (AFAO).