Q and A

Question

Why is my viral load fluctuating so much?

I was diagnosed HIV positive in early 2007. The results of my CD4 counts and viral load (VL) tests so far are as follows:

CD4=700, VL=6,000

CD4=580, VL=7,000

CD4=900, VL=24,000

CD4=580, VL=240,000

These are from the first test up to the most recent one. The last two are the most recent tests taken three months apart. I am concerned about the huge difference between these two. I am especially concerned about the rise in VL from 24,000 to 240,000 in the space of three months. I just wonder if this is normal. Is it not supposed to be a steady increase?

This really scares me as my doctor is reluctant to start me on HIV medication as my CD4 seems to be okay. As far as I understand, the higher the VL, the higher the risk of sickness. Would it not be better in this case to start treatment irrespective of the CD4 count? I am trying to be sensible and keep going for tests but looking at this, I am scared I am going to get sick anyway because the CD4 is blocking me from starting treatment.

Answer

Thank you for your question.

Please don’t be scared. When to start treatment is a big decision and it is great that you are actively seeking the information you need to make that decision.

You should speak to your doctor about a confirmatory test. It is important that you continue to monitor your CD4 and viral load results over the next few months to see what happens.

There are several possible reasons for your sudden increase in viral load. Firstly there could be an additional underlying infection. Secondly it could just be a viral load ‘blip’ which is where a sudden increase in viral load is seen and then it goes back down again. Unfortunately we do not yet know what causes this.

Finally it is possible that there was a mistake made with your lab results. The viral load test first multiplies the amount of virus found in the blood so that it can be counted. This means mistakes are easy to make. There is a 3-fold margin of error with viral load test which means that your results of 240,000 could be anywhere between 80,000 and 720,000copies/ml.

It is not usually the case that the higher the viral load the higher the risk of sickness. It is more the lower the CD4 the higher the risk of sickness as the CD4 count is measuring the state of your immune system. If the CD4 count is low then your immune system is also low and you are more likely to get sick. A CD4 count of 580 is still very good.

When to start treatment is your decision to be made in consultation with your doctor. You should not feel that anything is a barrier to your starting treatment.

If you are thinking of starting treatment you may find it useful to read the i-Base ‘Introduction to Combination Therapy’ guide.

17 comments

  1. Josh Peasegood

    Hi Amahle, using formula milk as mentioned will help to reduce the risk of transmission. Have you thought about using ART?

  2. Amahle

    Hi it Amahle thanks for response my EDD is on 19 December 2023 , I don’t want to breastfeed I will use a formula milk

  3. Josh Peasegood

    Hi Amahle, congratulations on your pregnancy. At 9 months do you have due date?

    Is there a reason you are not on treatment? Even if you are only taking treatment for a few days before giving birth, being able to reduce your viral load before birth will help to reduce transmission.

    Do you have any plans about how you are giving birth e.g., natural birth or a c-section?

    After birth baby will also be given their own treatment. This is explained more here: https://i-base.info/qa/19891

    How are you intending to feed baby? If you are looking to breastfeed it will be recommended that you are on treatment. This is because treatment will help to ensure viral load suppression. This in turn will help prevent transmission via breastmilk.

  4. Amahle

    Hi my viral load is 24,300 and cd4 count is 500 I don’t take treatment and am 9 months pregnant please assist me with information to not pass the sickness to my baby

  5. Lisa Thorley

    Hi Pebbles,

    Are you adhering to your medication? If you are then this could simply be a blip. Are you able to have your viral load retested?

  6. Pebbles

    My viral loads been 20 or below. I stated genvoya and now it’s detectable nd up 140. Are there meds for this and can vl go back down once it has rised

  7. Roy Trevelion

    Hi Mimi,
    It sounds like a good idea to think about changing treatment. The clinic might have said you must change treatment because the meds are not working well. What treatment are you taking and what have you been on already?

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