Q and A


Newly diagnosed in primary infection, why is my CD4 low and viral load high?

I’ve recently been infected and diagnosed with HIV.

I was diagnosed only 3 weeks after infection date, and started treatment immediately.

I thought that to start treatment this early was good, and I thought that my CD4 count would still be high.

I was really surprised when the first test showed unexpected results: after only three weeks from infection, my viral load was 240,000 and my CD4 count was 333. I started treatment the day after.

The doctors were surprised by the high viral load and low CD4 numbers in such a short time since infection. Can you please give me your view as to why that is?

Do you think I can expect my CD4 count to increase soon?

I’m currently on Truvada and Tivicyn, no side effects so far. Its been just 3 days.


Thanks for getting in touch.

How are you coping with your diagnoses? Are you able to get any support?

You did the best thing by starting treatment early. This is because you will have reduced the risk of damage to your CD count and other aspects of your immune system. You being on treatment will also reduce the risk of transmission to others. And because you started meds in primary infection, there is a very small chance that in the future you might be able to stop ART.

Having a high viral load this soon after infection is completely normal. This is because after a few weeks of infection a persons viral load will increase to very high levels. As a persons immune system fights back, it will drop, and this is even without meds.  Yours however,  will drop and drop quickly because you’re on meds. Within 3 months it should be undetectable.

With regards to your CD4 count, it being what you think is, ‘low’ is also normal. This is because during primary infection it will drop. After primary infection it will begin to increase. Within time, if it isn’t treated, it will then begin to drop. Owing to this, I don’t know why your doctors would be so surprised by this.

In response to your question, yes your CD4 will go up. Though to what level I can’t say. The average is between 400-1600. Anything in this range is good.

The meds that you’re on are a good combination. They do what they are supposed to do, which is control your HIV.

Because you’ve just been diagnosed, and because you’ve just started meds, you might find the following helpful:





  1. Lisa Thorley

    Hi Derick,

    CD4’s fluctuate all the time, so this common. To know for sure if your meds are working you’ll need your viral load result.

  2. Derick

    Hello there,

    After 10 months of tenof and efavirenz drugs my cd4 drop from 433 to 333 . But viraload still pending.

  3. Lisa Thorley

    Hi Phillip,

    What was your CD4 count when you were diagnosed? Are you on medication?

    If you’re on meds, then you’re already doing the best thing possible. This is because only ARVs’s can increase a persons CD4.

  4. Phillip

    If my CD4 count is 356 how can I make it to rise?


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