Question
How long should it take for my lab results to change after treatment?
2 January 2019. Related: All topics, CD4 and viral load, Starting treatment.
Hi there
I have recently been started by consultant on the combination of Truvada (tenofovir+FTC) and Sustiva (efavirenz), following results which showed my CD4 at 259 and viral load of around 90,000.
This was my second blood test. The first test, two months earlier, showed CD4 of 360 and viral load of 70,000, so my consultant felt we should start on HAART.
My question is, on my combination:
How quickly should my CD4 and Viral Load return to ‘normal’ ie when will get undetectable viral load, and when will my CD4 begin to rise?
Hope you can help.
Many thanks
Answer
Thanks for your question and the chance to post a reply online.
While CD4 results are the most important test before starting treatment, viral load results are more important once you are on-treatment.
Viral load usually drops very quickly when you start treatment – sometimes by 1 log in the first few days, and by another log in the next week or two.
A minimum response you should expect is to have at least a one log drop after 4 weeks treatment.
A ‘log’ is a factor of 10. For your figures, this means viral load could have dropped from 90,000 to 9,000 in the first week, and down to 900 within the first few weeks.
These are average results though, and there is a lot of variation between different people. Also, most clinics only check the effect of treatment after the first 2-4 weeks. Although you don’t get results on the very early effect it is good to know what is happening.
Most guidelines suggest that most people should become undetectable within 3 months. If your first combination includes and integrase inhibitor, most people become undetectable within one month.
If viral load starts at higher levels (i.e. over 1 million), it may take a bit longer, especially if your started treatment in very early infection.
CD4 counts are generally more slow to respond – and this is a good thing. If anything, getting a very rapid CD4 increase can sometimes be linked to complications, especially if you start with a low CD4 count (under 200 or under 100 etc).
As long as your CD4 count is above 200, there is little chance of any HIV-related complications, and the higher it goes, it is generally better.
For some people, this may never get much above 300 – but this is still good enough to keep them healthy for many years. Others may go past 600, and sometimes over 1000 – though there has not been any research that shows any specific benefits from very high levels in people when on treatment.
The idea of a ‘normal’ CD4 count is difficult – for some people this could be 400, for others it could be 1400. In practice, no-one has a CD4 count result from before they caught HIV – so knowing what is normal for any individualat best just a guess. As long as your counts starts to go up, how high it goes, and how fast it does it, isn’t something to worry too much about.
Keeping over 200-300 is the first goal and then aiming for >500.
It is very good that you have started treatment. Your count could rise by 10-20 a month or more. It should only be a worry if nothing happens, or if it starts to fall, and this can happen in a small percentage of people.
This answer was updated in January 2019 from a question first published in May 2007.
I think i agree with you because i had my results today vl went from 6000 to 292. My baby safe?
Hi nomnqusho,
Other than ARV’s there isn’t any other medication that you can take to help prevent transmission. Tribuss is however very effective.
Is there any medication to help prevention of HIV while my baby is still in the womb except for the Tribuss that I’m taking?
Hi Nomnqusho,
What’s your CD4 count and viral load?
Yes Tribuss will help reduce the risk of transmission to your baby. For more about HIV and pregnancy, please see here:
http://i-base.info/guides/pregnancy
Was drinking and smoking before i found out that am pregnant. And i fell pregnant june. Any harm done to my baby since am hiv positive. The tribuss medication am taking does it help prevent hiv transmission to my baby. Is my baby infected?
Hi Nomnqusho,
A persons viral load should become undetectable within 3 months of starting meds. However, in some cases this can take longer. Yours wasn’t very high to begin with, so its very possible that its already undetectable.
6000 Viral load when started treatment and found out m 2 months pregnant. CD4 was 575 at that time July. Have not done any test yet jus anxious to know the possible drop of viral
Hi Rachel
Treatment responses are individual. Although most people get an undetectable viral load within 3-6 months of starting treatment, a few people take a bit longer, especially if their viral load was very high when they started (ie over 300,000 copies/mL). Because I don’t know where you started, it is difficult to comment on this.
It sounds like you are good with not missing meds. Are you are taking them with food? It doesn’t matter what the food is, high or low fat etc, but food increases drug levels by about one third (about 30%), so this is important. The label for the ritonavir (Norvir) and atazanavir (Reyataz) should say this, but food also increase the levels of tenofovir (one of the tow drugs in Truvada).
A second thing your doctor should check is whether you are using any other meds that could be interacting with your HIV meds and reducing these drug levels. This can be over-the-counter, prescription, herbal or recreational drugs. For example, some antacids (for stomach gas and bloating) reduce levels of atazanavir.
Your doctor should also run a resistance test now. Having a viral load that is higher than 500 for more than six months could have allowed resistance to develop to any of your current meds. You can only check this while your viral load is still at detectable levels.
I have been on Truvada, Norvir and Reyataz for eight months. Just found out today that my viral load is still a little above 500 and CD4 is 263. I am concerned about the viral load being still detectable. Should I? They are going to try to run a resistance test to see what is happening. I am nervous all the time about this stuff and scared. I just lost my partner from full blown AIDS after being together 23 years. The doctors said I more than likely caught it from him. He was really bad when they found it on him, I haven’t missed medicines since I started and don’t plan to. I eat right and exercise. Am doing what I need to do? My doctor is so positive and keeps me motivated and says I will be okay but it is still scary.
Just confirming what Simon has said really.
I started treatment on Truvada (tenofovir+FTC) and Sustiva (efavirenz) last December.
My viral load was 30,000 when I started and hit undetectable in almost exactly two weeks.
My CD4 count initially dropped a little. After a month it had risen quite sharply and then settled down to a nice steady climb of around 20 per month.