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.

57 comments

  1. Lisa Thorley

    Hi Matthew,

    When someone starts taking ARVs their viral load should become undetectable within 1-3 months of starting treatment.

    As you’ve noted, we’re all different, therefore I can’t answer your final question as we don’t have this data.

  2. Matthew

    Hi. I’m a 48 year old white male in Florida and was diagnosed as HIV positive on 8/31/2021. My CD4 was 871 and my Viral Load was 4600. I was prescribed Biktarvy and have been taking it for one month now. Labs were drawn today (9/30/2021) and I’m waiting for the results.

    How common is it for the viral load to drop 2 ‘logs’ after 1 month? (Ex. Dropping to 46 from 4600)

    I know each patient is different but what has been the most a viral load has dropped after 1 month on record to date?

  3. Simon Collins

    Hi Joe, thanks for replying with details. Having the colon test is a good idea. Most people will be negative, but if positive it can be treated – response rate are much better when any cancer is diagnosed early. This is the reason for the screening.

  4. Joe

    Thank you for answering. No I wasn’t diagnosed with it but they made me take a test for colon just wondering if I do have it can it be treated? I’m just a little scared.

  5. Simon Collins

    Hi Joe, thanks for posting.

    How are you and how is everything?

    Finding out you are HIV positive can be difficult, but you are doing everything right.

    It was good that you found out before your CD4 count became much lower. It is also good that you started treatment straight away. The CD4 count of 152 and high viral load shows that you are likely to have been HIV positive for several years.

    HIV treatment will reduce your viral load and let your immune system become much stronger again.

    Treatment will prevent all sorts of health problems, including some cancers.

    Was the question about cancer a general question or were you also diagnosed with a cancer?

  6. Joe

    I was diagnosed with HIV on June 6 my cd4 count was 152 and VL 120000 I started my treatment the same day. Did I start my treatment at a good time and can a cd4 count of 152 still fight off cancer?

  7. 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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