Which condition requires a higher CD4 count for safe treatment of opportunistic infections?

Tuberculosis (TB) is an opportunistic infection that poses significant risks to individuals with compromised immune systems, particularly those living with HIV. When treating TB in patients with HIV, the CD4 count is a critical factor because it reflects the strength of the individual's immune response.

For effective treatment of TB and to prevent disseminated disease, a higher CD4 count is generally required, typically above 350 cells/mm³. This is because TB is a progressive infection that can rapidly worsen in immunocompromised individuals. If the CD4 count is low, there is a higher risk of severe disease and complications during treatment, including the chance of drug interactions and immune reconstitution inflammatory syndrome (IRIS).

In contrast, while HIV itself is crucial to consider in terms of CD4 counts, it is generally the primary infection that leads to a compromised immune state, not an opportunistic infection like TB which directly demands consideration of CD4 thresholds for treatment safety. Hepatitis B and COVID-19 are also significant infectious diseases but don’t typically require the same stringent CD4 count parameters for the initiation of treatment concerning opportunistic infections. Thus, the emphasis on a higher CD4 count is particularly relevant in the context of managing tuberculosis in individuals with HIV.