Question

My viral load is 10 million copies/mL in seroconversion…

6 January 2022. Related: CD4 and viral load, Newly diagnosed, Starting treatment.

Hi,

I was recently diagnosed with HIV. It is thought I contracted this within a few months ago. The ID doctor seems to think I am seroconverting.

My first lab results shocked me. My CD4 was 267 with a VL over 10 million. I feel healthy with just a slight dry throat and had recededing gums which has eased off. I am 30 years old, 6ft and weigh 11 stone.

My question is why such a high initial VL?

Does this indicate any problems with future CD4/VL i.e being VL being above 100,000 and so needing immediate treatment.

How soon could I expect my levels to level?

Many thanks

Answer

Answer: Simon Collins

Hi

I’m sorry to hear about your diagnosis, but I hope you are getting the information and support to make this easier.

It is common for viral load in very early infection to be over one million copies/mL.

The two studies referenced below report cases in seroconversion where this is greater than 50 million. Viral load tests are less sensitive at very high levels (over one million) so these very high figures just show these are possible.

The severity of seroconversion symptoms is an indication of how quickly HIV progresses after serconversion. People who have the worst symptoms often start HIV treatment earlier. Also, if symptoms are severe enough to be hospitalised, BHIVA guidelines include this as a reason to start HIV treatment.

UK guidelines generally recommend starting HIV treatment (ART) whenever someone is diagnosed. This includes in very early infection, even if you don’t have symptoms. See from page 33 at this link: https://www.bhiva.org/file/RVYKzFwyxpgiI/treatment-guidelines-2016-interim-update.pdf).

This also recognises that someone has to be ready to start treatment, but a high viral load is one of the reasons used to support early ART.

References

The first study reports median peak viral load of 6.5 log (3 million) with a range of 4.2 to 9.0 log) at median of 10 days (range 1 to 31) post symptoms.

The second study includes an example of a women in Kenya in early infection with a viral load of 57 million copies/mL.

1. Kaufmann GR et al.Impact of Early HIV-1 RNA and T-Lymphocyte Dynamics During Primary HIV-1 Infection on the Subsequent Course of HIV-1 RNA Levels and CD4+ T-Lymphocyte Counts in the First Year of HIV-1 Infection. JAIDS 22(5)437–444. (15 December 1999).
   https://journals.lww.com/jaids/Abstract/1999/12150/Impact_of_Early_HIV_1_RNA_and_T_Lymphocyte.3.aspx
2. Lavreys L et al. Virus Load during Primary Human Immunodeficiency Virus (HIV) Type 1 Infection Is Related to the Severity of Acute HIV Illness in Kenyan Women. Clinical Infectious Diseases, 35(1): 77–81. DOI: 10.1086/340862. (1 July 2002).
   https://academic.oup.com/cid/article/35/1/77/282492

This answer was updated in January 2022 and January 2016 from a question first posted in August 2010. The update is because guidelines now recommend ART in early infection.