Question
How quickly will my CD4 and viral load change after starting treatment?
25 January 2019. Related: All topics, CD4 and viral load, 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.
Hi Grace,
Yes its safe to start. Its also recommended. Talking to your doctor will help. Please see here: http://i-base.info/guides/starting
I tested Positive with Hiv in 1998 but my viral load is 35 and my Cd4 count is 539 , i never used any art s since but now i want to start with ART s, whats your advice , is it sage to start?
Hi George,
First, your CD4 count and your CD4% are within the normal range for someone who is HIV negative.
I’m not sure what the 5.5 means. If it’s a viral load result then it could mean the Log value.
But what did they say about sending your blood for confirmation?
i had hiv screening result 5.5. what is the unit of this. is this the viral load? i know i am hiv reactive yet because my blood being sent for confirmation. my cd4 740 and 34 percent.
Hi Remmy,
It’s good that your viral load is <20. That's undetectable so evn though you used to be late, it looks like the meds are working.
What ARVs are you taking. And why is it difficult fitting them in with your hard job? What does the doctor say about it?
I’m scared as I’ve not been taking my drugs in time for 4 months now.I used to be 2/ 3 hours late some most time due to the kind of hard job I’m doing now .what is going to happen to my viral load of <20 now
Hi Ammu,
If your mother has a CD4 count of 89 and TB she will need to be on medication for both the TB and the HIV. Is this something that’s been discussed with her?
My mother has a cd4 count of 89 and she has lymph node TB.
Hello Guy, We don’t have the resources to answer questions on testing and transmission. But questions on this have all been answered here. It does sound like you’re not well, but you can ask the doctor to find out what’s causing these symptoms.
Hello people ..I have most symptoms of hiv 1st .painful jonts,headaches sometimes in the morning,even that pimples around the neck that that’s long to cure,and my body is kind like soft,weight loss,the is this change in my face its like someone has punched me in the eye.. I went to the clinic at the 10th Jan 2018 it came Negative and the told me to come back after six weeks and I went back at the 21st Feb 2018 it came back Negative the thing is I know myself when am sick I feel it I haven’t been myself then,,all I need is medications but the test is Negative but I really feel sick people.