What if I am a slow progressor?

A small percentage of people have a very strong immune response to HIV.

People whose CD4 count stayed above 500 for five years without ART are called long-term slow progressors (LTSPs). If viral load also stayed undetectable, they are called elite controllers (ECs).

Most guidelines still recommended for the roughly 5% of people who are LTSPs or less than 0.1% who are ECs.

This is because HIV might be progressing in ways that are not shown by your CD4 count and viral load. For example, it might cause problems in your brain where HIV is difficult to monitor.

Most doctors think the benefits of ART are much safer than just continuing to monitor.

Also, an undetectable viral load when not on treatment is also very different to when taking ART. Viral load nearly always increases at some time when not on ART, and so U=U does not apply. This is where your HIV meds also stops sexual transmission, even without condoms.

Last updated: 1 June 2022.