Question
What is the importance of a high viral load with a high CD4?
18 July 2007. Related: All topics, CD4 and viral load, Living with HIV long-term, Newly diagnosed, Starting treatment.
I was infected with HIV 10 months ago.
My CD4 count is stable at around 750. However my viral load is still extremely high.
What does that mean and what could be the consequences?
Thanks
English is not my mother language, for online purpose you may rephrase my question.
Answer
Hi
Thanks for your question.
First, I’d need to know what your viral load results are. The figure is important because the terms ‘high’ and ‘low’ often mean different things to different people.
Usually, a ‘high’ viral load is over 100,000 copies/mL.
Because you were only recently infected your immune system (which is strong because your CD4 count is over 500 cells/mm3) may still bring your viral load down without treatment, to a lower level.
If your viral load stays high, this is likely to mean that your CD4 count will drop a bit more quickly than average. A high viral load is an independent risk for HIV progression, so in discussion with your doctor, you may want to consider using treatment a bit earlier.
This still wouldn’t normally be recommended while your CD4 count is over 500 cells/mm3 unless you have any symptoms.
Hi Lerato,
Are you still taking HIV meds? If you are, and viral load is now detectable, it can mean that your meds are not working. Being undetectable means that you can’t transmit HIV if you don’t use condoms (U=U). Can you talk to the doctor about your meds and find out why they’re no longer effective?
I’m HIV+ and my partner is HIV- and i have had unprotected sex with him several time and now my vira load is increasing (118%).. How bad could that be
Hi James, how are you doing? It is good that you were diagnosed early and have already started treatment. This level viral load makes is possible that you might have only recently become HIV positive.
This is because a few weeks after infection, viral load goes up to very high levels – sometimes to above 10 million – which the body then brings down by itself. If this is the case, your viral load was either on the way up or on the way down when your started treatment.
For your second question, HIV meds start to work from the very first pill. Within the first week, your viral load could easily have dropped from about 500,000 to 50,000 and this will continue over the next few months. Dolutegravir is an integrase inhibitor, and these combinations bring viral load down the quickest.
I was just diagnosed with HIV virus as my CD4 count is 474 and my viral load is 5603133 extremely high as I am on Descovy (tenbofovir/emtricitabine) and Tivicay (dolutegravir) as I have only started the meds 2 weeks ago will my viral load drop. Thanks.
Hi Legato, thanks you for writing with your question. Based on this information your doctor should want to either check the viral load test again or change your treatment.
It sounds like the treatment worked very well for the first year as your CD4 response is very good. If the viral load is now so high though and you have been taking all your meds, then you have just been very unlucky. The cause might be that when you first started treatment your HIV was already resistant to one of the drugs in your combination.
Perhaps you caught HIV from someone who already had drug resistance, which is quick common.
This would mean you were only on a combination with two active drugs rather than three.
If viral load has rebounded so high to 85,000, you are likely to now have resistance to other meds in your combination. In the UK this would mean changing a new combination.
Hi, i’m Hiv positive and have been on treatment for a year now. I started with 127 cd4 now its 266. in march my viral load was less than 40 now I just discovered my viral load is now 85,522 which I believe is too much. I am drinking my meds everyday but I want to what could be the cause… thank u
Hi Nkomo,
A CD4 of 1006 is high. However, even if it is high the World Health Organisations recomendations are that everyone who is HIV positive should be on medication. Being on medication not only helps your health as the START study shows:
http://i-base.info/i-base-qa-on-the-start-study-results/
It also reduces the risk of transmission.
How important is it to start HIV treatment if your CD4 count is 1006? I’m not sure about my viral load at the moment.
Hi Lauryn,
Your CD4 is good, but your viral load is detectable. This means that their is a risk of you transmitting HIV. If you aren’t already on treatment, then this is something that you should think about. This is because the World Health Organisation recommend that everyone who is positive is on medication.
Being on meds will help control your HIV and bring your viral load to less than 50 copies.
I’m HIV+, and my CD4 is 580, while my viral load is 25,000 am I sick?