Question
How quickly does viral load drop on treatment?
5 July 2020. Related: All topics, CD4 and viral load, Starting treatment.
I’ve been trying to understand on average, the daily rate of decrease in viral load following initial treatment.
I’m guessing that this changes over time and varies from case to case according to the chosen treatment, CD4 count and viral load level and possibly other factors.
However, supposing that the viral load is around 100,000, the CD4 count is around 400 and the treatment used is Atripla, could anyone please let me know the expected % decrease of viral load level per day at least within the 1st month of treatment?
Thank you for the help.
Answer
All HIV combinations (ART) starts working from the first dose.
Viral load is usually reduced by 90% (also referred to as 1 log) within the first few days. It then continues to fall but not as quickly (see below) until it becomes undetectable.
A log is a number mulitplied to the power of 10. So with a viral load of 100,000 copies/mL, a 1-log reduction would bring your viral load down to 10,000 copies/mL and a 3-log reduction would reduce it to 100 copies/mL. (See this factsheet).
You are right that individual factors will lead to difference rates of viral load reductions. These include:
- How high your viral load was when you start ART.
- The medicines in the combination (integrase inhibitors casuing the fastest drops).
- The drug levels of this meds (related to adherence and how they absorb and processes drugs).
- Good adherence – not missing doses.
UK and US guidelines recommend that your viral load should be undetectable within three months. However, many people achieve this within the first month, especailly if they are using an integrase inhibitor.
Some people take longer, especially if their viral load is very high when they start treatment.
Lots of studies have reported detailed early responses ART, including for efavirenz-based combinations like Atripla.
This decline is often referred to as having three main phases.
The first phase is very rapid – referred to in some studies as being the first few days and in others as within the first two weeks. This is where the actively infected CD4 cells are targeted. CD4 cells infected with HIV only live for a few days and when you start treatment this virus and these cells are quickly reduced.
This results in a viral load drop of perhaps 99% (2 logs) within two weeks.
The second phase, out to the first month is slower, as it is working on cells that live longer. This can easily reduce viral by another 90% (another 1 log reduction). In people with very high viral loads when they start treatment, this second phase may continue for longer until viral load becomes undetectable.
Some researchers also talk about a third phase decline which occurs even more slowly and gradually once your viral load is undetectable.
This relates to a reduction in the levels of infected CD4 cells that are latent (or resting). This pool of cells only slowly decreases over time.
This link is to an early study describing the two-phase viral load reductions.
This answer was updated in July 2020 from a question first posted on 15 September 2012.
Hi there I’m hiv positive and on art for 9 years now.But I currently have bleeding stools so I went for a checkup and the doc said my white blood cell count is very low does this mean I’m very sick because she asked me if u had an hiv test done before because it can be the other reason for my low white blood cell count.I’m due for colonoscopy and gastrocoscopy in a few days to determine where the bleeding is coming from.But I’m taking my ARVs daily as usual so I’m worried.Please assist ragarding low white blood cells I saw on the letter wich came from the lab it’s state 2.9L.
Please can you find out more about the meds you’re taking?
If you mean you cannot start on HIV treatment it probably means that you are being treated for TB for a few weeks first. Is that what the doctor said?
Please let us know more about your meds. And how are you feeling?
My cd 4 was 23 now i have started on tb treatments and sypchotic treatments can that help me to decrease my viral since that i cannot starg on hiv treatments
Hi Victor,
It’s good that you tested negative. Did you take PEP? Was your exposure high risk?
Hi I have been exposed to HIV six weeks ago but am still testing negative what should be taking place or what can I do at the moment?
Hi Carmelo.
When a person starts ARVs, their viral load should ideally become undetectable within 1-3 months, so yes its common that a person’s viral load will be undetectable within a month.
Hey if my viral load was 15000 after I took my meds my first month of treatment it’s now 18 is this right I’m undetectable so quick
Hi Thato,
The only way to know what your viral load is, is to have it tested. This is the only way.
Hi there,
How do I go about knowing my viral load? . I was diagnosed in September, 2018. On atrozia treatment for 3 months now and my cd4 then was on 144, so am very anxious about my progress if my viral load is dropping or not or even the medication is working but I don’t miss a dose… I was told at the clinic that il know about my viral load after six months.
Hi Mr too,
ARVs are what reduces a person’s viral load, are you on these? If you are then you’re already doing the best thing possible. If you aren’t on medication they you will need to start it.