Next page: What if your viral load rebounds?
If your viral load never became undetectable…
How quickly should viral load become undetectable?
When you first start ART, viral load drops quickly. It often becomes undetectable within a month. If not, then within three months. But sometimes this can take longer.
The time it takes depends on several things.
- Your viral load when you start. The higher this is, the longer it might take to come down.
- Which HIV drugs you use. Combinations that include an integrase inhibitor reduce viral load faster than other types of HIV drugs.
- Adherence. Drugs can only work if you take them. If you take your meds on time, viral load comes down more quickly.
Viral load should drop by at least 90% in the first month. This is sometimes referred to as 1 log (see Table 1 below). If not, your doctor will ask you about adherence and may run other tests.
If viral load is still high after three months, it is normal to change ART.
One exception
However, there is one exception that is still not understood very well.
In rare cases, it can take more than a year to become undetectable without needing to change treatment. This is if the low level viral load comes from a reservoir of sleeping cells. In this case the combination is not failing.
This can happen if you are diagnosed very soon after infection. Also after starting treatment very early with a very high viral load.
However, your clinic can’t really test for these rare cases. It has to be interpreted based on very high adherence to a combination that really should work.
However, if your doctor added a new drug to you current combination and it makes no difference, this could be interpreted as the viral load coming from the reservoir. See the report below for more information.
What is second-line treatment?
Second-line is the name for your second combination.
If the second ART fails, the next one is called third-line.
How long should I wait before changing ART?
This depends on your individual viral load results.
It also depends on the choices you have for your next treatment.
Table 1: Log scales (a log 10 scale is a multiple of a factor of 10).
| 1 log = 10 | 1.5 log = 30 | 1.7 log = 50 |
| 2 log = 100 | 2.5 log = 300 | 2.7 log = 500 |
| 3 log = 1,000 | 3.5 log = 3,000 | 3.7 log = 5,000 |
| 4 log = 10,000 | 4.5 log = 30,000 | 4.7 log = 50,000 |
Last updated: 1 January 2025.