Q and A

Question

How long should it take for my lab results to change after treatment?

Hi there

I have recently been started by consultant on the combination of Truvada (tenofovir+FTC) and Sustiva (efavirenz), following results which showed my CD4 at 259 and viral load of around 90,000.

This was my second blood test. The first test, two months earlier, showed CD4 of 360 and viral load of 70,000, so my consultant felt we should start on HAART.

My question is, on my combination:

How quickly should my CD4 and Viral Load return to ‘normal’ ie when will get undetectable viral load, and when will my CD4 begin to rise?

Hope you can help.

Many thanks

Answer

Thanks for your question and the chance to post a reply online.

While CD4 results are the most important test before starting treatment, viral load results are more important once you are on-treatment.

Viral load usually drops very quickly when you start treatment – sometimes by 1 log in the first few days, and by another log in the next week or two.

A minimum response you should expect is to have at least a one log drop after 4 weeks treatment.

A ‘log’ is a factor of 10. For your figures, this means viral load could have dropped from 90,000 to 9,000 in the first week, and down to 900 within the first few weeks.

These are average results though, and there is a lot of variation between different people. Also, most clinics only check the effect of treatment after the first 2-4 weeks. Although you don’t get results on the very early effect it is good to know what is happening.

Most guidelines suggest that most people should become undetectable within 3 months. If your first combination includes and integrase inhibitor, most people become undetectable within one month.

If viral load starts at higher levels (i.e. over 1 million), it may take a bit longer, especially if your started treatment in very early infection.

CD4 counts are generally more slow to respond – and this is a good thing. If anything, getting a very rapid CD4 increase can sometimes be linked to complications, especially if you start with a low CD4 count (under 200 or under 100 etc).

As long as your CD4 count is above 200, there is little chance of any HIV-related complications, and the higher it goes, it is generally better.

For some people, this may never get much above 300 – but this is still good enough to keep them healthy for many years. Others may go past 600, and sometimes over 1000 – though there has not been any research that shows any specific benefits from very high levels in people when on treatment.

The idea of a ‘normal’ CD4 count is difficult – for some people this could be 400, for others it could be 1400. In practice, no-one has a CD4 count result from before they caught HIV – so knowing what is normal for any individualat best just a guess. As long as your counts starts to go up, how high it goes, and how fast it does it, isn’t something to worry too much about.

Keeping over 200-300 is the first goal and then aiming for >500.

It is very good that you have started treatment. Your count could rise by 10-20 a month or more. It should only be a worry if nothing happens, or if it starts to fall, and this can happen in a small percentage of people.

This answer was updated in January 2019 from a question first published in May 2007.

11 comments

  1. Lisa Thorley

    Hi Nomnqusho,

    Its great to hear that your viral load is nearly undetectable. This is very important. Its not possible to say if your baby will be OK or not, this is why babies need to be tested and why they need to take medication when they are first born. The risks though are much less when someone has an undetectable viral load. And you’re nearly there.

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