Q: What if CD4 does not rise despite viral suppression?

This is known as immunological non-response. Consider factors such as older age, low nadir CD4, coinfections (TB, hepatitis), malnutrition, and thymic dysfunction. Do not change ART if the viral load is suppressed. Optimise nutrition and manage comorbidities.

Q: Can I stop OI prophylaxis based on CD4 trend?

Yes. Prophylaxis can be discontinued once CD4 rises above the threshold for ≥3–6 months on suppressive ART. For example, PJP prophylaxis can be stopped when CD4 >200 cells/μL for ≥3 months.

Question 1

How often should CD4 be monitored?

Accepted Answer

In patients on stable ART with suppressed viral load, CD4 can be monitored annually. More frequent monitoring (every 3–6 months) is indicated in the first year of ART, when switching therapy, or when the CD4 count is <200 cells/μL.

Question 2

What if CD4 does not rise despite viral suppression?

Accepted Answer

This is known as immunological non-response. Consider factors such as older age, low nadir CD4, coinfections (TB, hepatitis), malnutrition, and thymic dysfunction. Do not change ART if the viral load is suppressed. Optimise nutrition and manage comorbidities.

Question 3

Can I stop OI prophylaxis based on CD4 trend?

Accepted Answer

Yes. Prophylaxis can be discontinued once CD4 rises above the threshold for ≥3–6 months on suppressive ART. For example, PJP prophylaxis can be stopped when CD4 >200 cells/μL for ≥3 months.