Treatment training manual

1. 8 How quickly does HIV progress without ART?

Without HIV treatment (ART), HIV progresses at different rates in different people.

The graph below shows three rates for the CD4 count can drop to 200 cells/mm3 in someone who is not taking ART.

HIV progression in different people

Having serious illness when they are first infected (during seroconversion) is a risk for faster HIV progression.

There is no test to know how quickly HIV will progress, other than by monitoring the CD4 count over time.

People who progress more quickly get as good a response to treatment, as people who progress more slowly.

Approximate time for CD4 count to drop to 200 cells/mm3 (without ART).

  • 25% people would take 1-2 years and (fast progressors).
  • 50% people would take 2-10 years.
  • 25% people would take 10-15 years.
  • Less than 1% people might not see any drop in their CD4 count even after 15 years. These people are called long term slow progressors (LTSPs). Even more rarely, some people not only keep a strong CD4 count, but they also keep an undetectable viral load. These people are called “relite controllers”. Viral load is discussed in the next chapter.

These time to progression results are based on a UK study of people who were diagnosed during seroconversion. Everyone in the study was then followed over time to see how their CD4 count changed. These results may overestimate how quickly HIV progresses because people are often diagnosed early because of symptoms.

Link to UK Seroconvertors Study.

Time between infection and the need to start treatment

Since July 2015, most guidelines recommend ART at any CD4 count.

This means that CD4 monitoring until treatment is started is becoming less common: most people now start ART after they are diagnosed.

Last updated: 1 January 2016.