Chart — Med-Surg
CD4 Count & Opportunistic Infections Chart
In HIV, the CD4 count is a thermometer for immune reserve — and specific opportunistic infections show up at predictable thresholds as it falls. Knowing the ladder tells you what to watch for, when prophylaxis starts, and how worried to be about a new symptom.
Educational use only. CD4 thresholds and prophylaxis regimens are guideline-directed and approximate; verify against current infectious-disease guidance. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The CD4 Ladder
| CD4 Range | Status | Characteristic Infections | Nursing Focus |
|---|---|---|---|
| 500–1,500 cells/mm³ | Normal range | Immune function essentially intact; routine infections only | Goal of ART: keep CD4 here. Routine health maintenance and vaccinations per plan |
| 200–500 cells/mm³ | Mild–moderate suppression | Bacterial pneumonia, TB reactivation, herpes zoster, oral/vaginal candidiasis, oral hairy leukoplakia | Reinforce adherence; screen for TB; treat thrush; watch for shingles |
| Below 200 cells/mm³ | AIDS-defining threshold | Pneumocystis jirovecii pneumonia (PCP); also esophageal candidiasis | PCP prophylaxis begins (commonly TMP-SMX); dry cough + exertional hypoxia = think PCP |
| Below 100 cells/mm³ | Advanced | Toxoplasmosis (brain), cryptococcal meningitis | Add prophylaxis per protocol; report headache, confusion, neuro changes, neck stiffness |
| Below 50 cells/mm³ | Severe / end-stage immunosuppression | Mycobacterium avium complex (MAC), CMV (retinitis → blindness) | Primary MAC prophylaxis is no longer routine if effective ART is started (2020 NIH/CDC/IDSA OI guidelines) — reserve azithromycin prophylaxis for those not on or not suppressed on ART; urgent ophthalmology for any visual change (floaters, field loss) |
Reading the Ladder
The single number to memorize is 200: at or below it, the patient meets the AIDS definition and PCP prophylaxis begins. Below that, the picture worsens in steps — neuro infections in the low 100s, then MAC and CMV under 50. ART that restores the CD4 count reverses this risk ladder, which is the entire argument for adherence: raising the CD4 closes these doors one by one.
NCLEX Pearls
- ✦CD4 below 200 = AIDS-defining and the cue to start PCP prophylaxis (often TMP-SMX).
- ✦Dry cough + exertional dyspnea + fever in advanced HIV → Pneumocystis pneumonia.
- ✦Headache, confusion, or neck stiffness at very low CD4 → think toxoplasmosis or cryptococcal meningitis.
- ✦Visual changes with CD4 below 50 → CMV retinitis; treat as an urgent ophthalmology referral.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →