If you had a low CD4 count when you started HIV meds, you may think you’re in trouble. Maybe you remember that after looking at data from large numbers of HIVers, researchers reported two years ago that your CD4 count just before starting HAART predicts whether you will get sick or even die during your first three years on meds. But there’s reason to exhale: A new study of the same group shows that your CD4s (and viral load) at six months into treatment, not at the start, most reliably indicate your future health. (Snag a calculator to gauge your risk at www.art-cohort-collaboration.org/hiv_form.htm.)

Suppressing viral load boosts CD4s

It’s a little like a seesaw: When your viral load goes down, your CD4 count goes up. British researchers tracked more than 200 HAART-starting HIVers who managed to get their viral loads down to 500 or below (“undetectable”) and keep them there for a year or more. The reward for these folks (and their good adherence)? During two years of treatment, their CD4 counts rose by a nifty 319 from an average start of 175. The biggest gain was in the first month—almost 100 cells. A slow climb followed, with gains of a dozen cells each month in the first year, down to five a month in the third. In the end, over 40 percent had more than 500 CD4 cells. The moral of the study? When the virus is beaten down, immune system recovery may be pokey, but it is possible.