Question

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.

301 comments

1. Sani • 11 April 2017

   Hi Lisa This is Sanni again. I have been on Atripla since June last year and I got my viral load result today when I went to get my drugs at my healthcare center. I took the viral load test on February. My viral load is still about 24,206 which is still high. I feel defeated because with how long I have been on drugs I was hoping it will be down to undetectable. This is the first viral load test I have done and I’m due for another test in August. I also got diagnosed with a cd4 count of 552 but its also down to 517. I don’t know why. Because I take my meds everyday. My doctor suggest I stick strictly to a particular time because I usually take my drugs from 10pm to 10:30pm timeframe.
   I have tried to be strong since I got pos but this is such a huge defeat for me. I don’t know if maybe I’m overreacting. I’ll just like to hear your views on my situation and how to move forward now. Because I want to live a long and healthy life. Thank you
   Also I’ll appreciate it if you can link me up with any support group in Nigeria. And I would also like to to have your email. Thanks

2. Lisa Thorley • 11 April 2017

   Hi Esther,

   Being diagnosed with HIV can be a shock. Give yourself sometime to breath and slow down. You’ll be OK.

   You’re already taking control of your HIV because you’re on meds.

   Accessing a support group can help. Where are you in Kenya?

3. Esther • 11 April 2017

   Hi, I stated my treatment five days ago, with a CD4 count of 309. I was diagnosed 2weeks ago but haven’t been able to talk to anyone yet except the doctor and a nurse. I feel a bit weak, but with all the comments I am reading online everyone has their own experiences. Are there any support groups I could join. I am in Kenya.

4. Lisa Thorley • 10 April 2017

   Hi Mike,

   You’re going to have to give yourself some time. Try and get some rest. Eat well, and basically do what people who are negative should do, look after yourself.

   You’ll get there.

5. Mike • 10 April 2017

   Hi Lisa,

   Me again, so as mentioned I’ve been on the new medication now for almost 2 weeks, I still feel tired and like I have the flu. Even at work my energy level is really low, what can I do to improve my level of energy? I trying to get over the depression but feeling tired like this isn’t really helping.

   I have a job that I love and I need energy to do it. What should I do?

   Thanks

6. Lisa Thorley • 10 April 2017

   Hi Mike,

   Depression in people who are living with HIV is common. More so in the first year of diagnoses. It will though get better once you get used to taking your meds.

   Being diagnosed can sometimes lead to a person grieving for their old life. Once this is done, it makes it easier to accept your status and move forward. Its something that can’t be rushed. But can be helped by talking to people about your anxieties and fears. If you don’t feel like talking, try writing. Or go for a walk and shout in the middle of a field.

   In time you will learn to embrace what’s happened. Like I’ve said, HIV will live with you, not you it.

7. Mike • 10 April 2017

   Thanks for the help! I’m hoping that in a couple of weeks I will feel myself again, I’ve been felling very strange but I think it’s a little bit of depression and not the new meds. Any recommendations about how to get over this depression and go back to my happy place?

8. Lisa Thorley • 7 April 2017

   Hi Mike,

   You’re welcome. I’m pleased that I’ve been of some help.

   Firstly the Odefsey is working, and working really well. Before you know it your viral load will be undetectable. This is a great sign. Your CD4 is also excellent. What all this means, is that your HIV is getting controlled, and really well. This is something that you should happy about.

   I’ve never had people get in touch saying that they’re having problems with Odefsey, this doesn’t mean to say though that this doesn’t happen. As with any form of powerful medication your body just has to get used to it. This will happen.

   I understand that it can be easy to get consumed by negative things that you read about ART. However, ART is now excellent and its very possible to live well with it. Just try and give yourself sometime. The fact that you’re doing so well is, like I’ve said a great sign.

   With regards to talking to someone online, you could try the Terrance Higgins Trust. THT are based in the UK, they do however have an online forum. If you aren’t in the UK, then if you tell me which country you live in I may be able to find you something. Or would a peer support group work better?

   Either way, you aren’t alone in this. There is help and support out there. And if its any help it does get better and easier with time. It is though an interesting journey.

9. Mike • 7 April 2017

   Hi Lisa,

   Thanks for the response, so when I got diagnosed my viral load was 97,000 and I only took the atripla for a month and just got switched over to Odefesey.

   Do you have any online groups you would recommend? At the end of the day I think I’ve been reading so many negative things about the medication, that it’s the only thing I’m focusing on. Do you have a lot of stories of people on Odefsey that are back to having a normal happy life with a lot of energy?

   I spoke to my doctor today and he said I should feel even better once my viral load is negative, I’m already at a viral load of 1600 and have a CD4 count of 620.

   Thanks again for the help, it’s nice to talk to someone besides my doctor.

10. Lisa Thorley • 7 April 2017

    Hi Mike,

    Being diagnosed with HIV can be tough. It will though get easier with time. Just give yourself some space to breath. What might help is talking to others who are positive. Is there a support group near to where you live? Or maybe you could try something online?

    Its common that people react badly to Atripla, or more specifically the efavirenz that are in Atripla. So changing seems like it was the right thing for you. However, do you know why you were given Odefsey? I’m asking because this is usually only given to people who are treatment naive and have a viral load of less than 100,000. As the following discusses:

    http://i-base.info/guides/11382

    I appreciate that you’re frustrated because you’re not feeling yourself, you have however just started meds. You need to give your body sometime to adjust and get used to what it is that you’re taking. If the tiredness continues, then this is something that you will need to look at. There is however, a possibility that the tiredness isn’t related your meds, but other factors. Of which one is stress.

    Because you’ve just started meds, you may find the following guide helpful:

    http://i-base.info/guides/starting