Q and A

Question

How quickly will my CD4 and viral load change after starting treatment?

I started ARV (efavirenz and AZT 3TC) three day ago. My CD4 count is 50.

How long do i need to wait for my treatment to bring up my CD4 count above 200 and to get my viral load undetectable?

Are there other treatments to bring up my CD4 count more quickly?

Answer

There can be a wide range of responses to treatment in terms of the time is takes to see changes in your viral load and CD4 count.

In general, viral load falls more dramatically and more quickly. It may drop by 1 log in the first few days of treatment and by another log in the next week or two. A ‘log’ is a factor of 10, so if your viral load drops by 2 logs, it is like knocking the last two digits of your starting level: i.e. getting from 100,000 down to 1,000.

If this is your first treatment, your viral load should drop by a minimum of 1 log over the first month, Actually, if your combination includes an integrase inhibitor, many people become undetectable (<50 copies/mL) within the first month. or many people will be undetectable. Nearly everyone else becomes undetectable within three months.

The time also depends on how high your viral load is when you start treatment. If you starts very high (over 1 million copies/mL) then it may take up to 6 months. Some people starting treatment in very early infection with viral load this high might even take 12-14 months to become undetectable.

However, if you don’t see a similar rapid drop at the start, or if it starts to go higher again at any time, your treatment may be failing.

CD4 counts respond more slowly, but there are also a wide range of responses in different people. It could take a year for you to get back over 100, and another year to get over 200. Although this may seem like a long time to you, because the trend is increasing, your immune system will also be getting stronger, and people don’t generally develop new infections as the same CD4 count, when they are starting treatment, compared to people at the same CD4 count who are not on HIV treatment.

You may find that it increases much quicker than this – some people get early dramatic increases, but a slow steady increase is probably better.

There are not really treatment that make your CD4 count increase more quickly. HIV drugs work by reducing your viral load first, so that your immune system recovers by itself afterwards.

This answer was updated in January 2019 from a question first posted in August 2006.

51 comments

  1. Lisa Thorley

    Hi Diego,

    Though a viral load of 600,000 seems a lot, many people are diagnosed with a CD4 in the millions. Even with a viral load in the millions with treatment it will come down.
    As you were diagnosed with a low CD4 count it’s very possible that you were diagnosed in primary infection. Therefore it’s very possible that your CD4 count is already much higher.

    With HIV the key is treatment, you’re on treatment so you’re already doing the right thing.
    Stress and anxiety aren’t good for anyone, so if you can it might be worth getting some support for this.

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