Question
My viral load is 10 million copies/mL in seroconversion…
6 January 2022. Related: CD4 and viral load, Newly diagnosed, Starting treatment.
Hi,
I was recently diagnosed with HIV. It is thought I contracted this within a few months ago. The ID doctor seems to think I am seroconverting.
My first lab results shocked me. My CD4 was 267 with a VL over 10 million. I feel healthy with just a slight dry throat and had recededing gums which has eased off. I am 30 years old, 6ft and weigh 11 stone.
My question is why such a high initial VL?
Does this indicate any problems with future CD4/VL i.e being VL being above 100,000 and so needing immediate treatment.
How soon could I expect my levels to level?
Many thanks
Answer
Hi
I’m sorry to hear about your diagnosis, but I hope you are getting the information and support to make this easier.
It is common for viral load in very early infection to be over one million copies/mL.
The two studies referenced below report cases in seroconversion where this is greater than 50 million. Viral load tests are less sensitive at very high levels (over one million) so these very high figures just show these are possible.
The severity of seroconversion symptoms is an indication of how quickly HIV progresses after serconversion. People who have the worst symptoms often start HIV treatment earlier. Also, if symptoms are severe enough to be hospitalised, BHIVA guidelines include this as a reason to start HIV treatment.
UK guidelines generally recommend starting HIV treatment (ART) whenever someone is diagnosed. This includes in very early infection, even if you don’t have symptoms. See from page 33 at this link: https://www.bhiva.org/file/RVYKzFwyxpgiI/treatment-guidelines-2016-interim-update.pdf).
This also recognises that someone has to be ready to start treatment, but a high viral load is one of the reasons used to support early ART.
References
The first study reports median peak viral load of 6.5 log (3 million) with a range of 4.2 to 9.0 log) at median of 10 days (range 1 to 31) post symptoms.
The second study includes an example of a women in Kenya in early infection with a viral load of 57 million copies/mL.
- Kaufmann GR et al.Impact of Early HIV-1 RNA and T-Lymphocyte Dynamics During Primary HIV-1 Infection on the Subsequent Course of HIV-1 RNA Levels and CD4+ T-Lymphocyte Counts in the First Year of HIV-1 Infection. JAIDS 22(5)437–444. (15 December 1999).
https://journals.lww.com/jaids/Abstract/1999/12150/Impact_of_Early_HIV_1_RNA_and_T_Lymphocyte.3.aspx - Lavreys L et al. Virus Load during Primary Human Immunodeficiency Virus (HIV) Type 1 Infection Is Related to the Severity of Acute HIV Illness in Kenyan Women. Clinical Infectious Diseases, 35(1): 77–81. DOI: 10.1086/340862. (1 July 2002).
https://academic.oup.com/cid/article/35/1/77/282492
This answer was updated in January 2022 and January 2016 from a question first posted in August 2010. The update is because guidelines now recommend ART in early infection.
Hi Rodel, it is only a second viral load test to confirm the result. As you have a CD4 count of 9 it does suggest that your current regimen is not working.
While it can take up to a year in rare cases for viral load to be undetectable, it only takes a few months to become suppressed (e.g., below 1000). It is important for the viral load to be suppressed so HIV is no longer damaging CD4 cells.
Have you been offered another treatment called co-trimoxazole? This is used in patients with a CD4 count below 200 to help protect from other infections as your immune system is recovering.
There are a number of HIV drugs that can be used and most work in slightly different ways. This means that if you are resistant to one type, it is likely that a different ‘class’ of drug will be able to work. As you are still testing high with your viral load has your doctor recommended switching treatment?
Hey Josh,
My cd4 is less than 50 (9, to be specific). No, I wasn’t offered anything to confirm the 12.6 million viral load. What test do you have in mind? No test has been conducted yet related to resistance.
However, some HIV doctors said that Viral load could sometimes take a year or two to be undetectable.
What I’m afraid of is that I might run out of ARV medications should I continue to be resistant. Help!
Hi Rodnel, ARVs should suppress someones viral load within 3 months. Have you been offered any further testing to confirm these results?
12.6 million copies/ml after being on treatment since March would suggest your current regimen is not working. This needs to be confirmed before switching. Have you had any testing for resistance to any types of medication?
Have you had any CD4 count testing?
My Viral load is 12.6 million copies/ml (I just received it today). I started taking ARV last March 30, 2023. Does that mean the medication is ineffective and the virus is resistant? Could someone share their thoughts on this, please?
Hi Bheki,
Thank you.
It’s important to tell the doctor about your partner’s side effects. When starting ART with a low CD4 count antibiotics should be taken to stop other infections.
Please also talk to the doctor about IRIS. IRIS occurs because the immune system quickly becomes stronger and identifies infections that it was previously too weak to fight. That’s another reason why antibiotics can be given.
Hi. Thank you for your guidance it really makes things better as I can see that it was really taking it’s tall on me coz I think I was stressing a lot due to this very high viral load
I did go into the links provided and they were very helpful
I’ll patiently wait for the viral load to decline while supporting
My worry now is how long this side effects will last. He is shivering and indicates a memory loss after waking up. Is there anything that i can do to help with this? As viral load decreases and cd4 increase will they go away in time?
Hi Bheki,
I’m sorry to hear about your partner’s recent diagnosis. Testing positive can be a tough time for all of us. But please see this page about just finding out you’re positive. You can see from this link that you’re already supporting your partner by asking for info from i-Base. That’s great.
It’s good to know that starting HIV treatment (ART) can reduce viral load by 90% in the first few days. ART can then reduce viral load by 99% in the first few weeks. As ART wipes out most actively infected CD4 cells, the immune system then has the chance to recover naturally. However, in contrast to viral load, CD4 usually increases more slowly and steadily.
Please see this page from ART in Pictures.
If your partner is thinking of taking multivitamins please tell the doctor about this. Some ARVs can interact with some vitamins and supplements.
Please see here for info about Trenvir.
Hi. My partner just got diagnosed a week ago and his vl is 2 6000 000 and cd4 count is 88.
1. How do I support him as my partner
2. He is stressing and not taking this well plus his work is stressful and he decided to stop for a while
3. How long should it take for him to recover, increase cd4 and lower viral load
4. He is taking his treatment now for just under a week. Trevir. Can we take them with multivitamins too and what can u recommend
Sometimes I feel like he is losing his mind a bit
Thank u for the good job u are doing
Hi Santosh,
If your viral load is 20 million, this means that it’s very likely that you’re currently going through seroconversion, or you were when your viral load was done. With medication this will go down.
It’s a myth that people will have symptoms when they seroconvert, some people do, whereas others don’t have any. It’s just a case of luck.
If your piles are bleeding, please see a doctor about this.
My viral load is above 20 millions
It means that my lever is infected badly or not?
However I am not feeling any symptoms except bleeding due to piles.