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.
i was diagnosed with Hiv positive on the 25 January 2019 with cd4 count 334 viral load was 134000 and did the second one after 2 weeks, cd4 285 and 1140 viral load, cd4 dropped must i worry about the cd4 count results?
Thank you very mouch Lisa! But i dont know why!! But i have all symptoms of hiv! And my test is always Negativ..Thank yoi
Hi Xhoni,
If you aren’t positive, you don’t need a CD4 count test.
Thank you very mouch Roy, but i want to ask about CD4, Is it necessary to do CD4 analysis? The HIV test has gone negative! or CD4 should be done only when the test is positive? please tell me. Answer me from you. And thank you very much
Hi Xhoni,
Please see my previous answer and the link below for accuracy of tests and window periods.
Hello Roy, a high risk exposure it is been before 10 years! But i doit all tests, and all of them are Negativ! How is accurate and safe is hiv test after 10 11 years, please tell me.
Hi Andres,
When someone starts ARVs their viral load should become undetectable within 1-3 months of starting treatment. However, in some cases it can take slightly longer. This is why its important to have your viral load test. When you go back in 2 months time its very likely that there will have been a significant drop.
A persons CD4 count rises at a much slower rate than to a viral load drop. Its not possible to say how long it will take for it to get to 500, or if it will.
When you’re positive its important to have your viral load under control.
The treatment that you’ve been given is fine. There’s more about treatment here: http://i-base.info/guides/starting
Its ok to drink beers when you’re positive. The main thing is that you don’t over do it.
HIV is now a very treatable condition. And one that shouldn’t interfere with you having a great life.
Hi, My name is Andres, I’m writing from Colombia, I was recently diagnosed with HIV and I got my test results today, I got a CD4 count of 285 and a viral load of 700.000, my HIV specialist prescribed me today with Lamivudine and Atazanavir/ritonavir, I will have a new CD4 count and VL test in 2 months.
How long it would take for me to be undetectable with this treatment? And how quickly could my CD4 count be over 500?
Another thing could I drink alcohol under this treatment? I’m not a crazy drinker but when I go out with friends usually drink 4-6 beers, is that okay? Or should I stop drinking? How it will affect me?
Thank you so much for all your help!
Hi Xhoni,
When did you have a high risk exposure to HIV? Please see this link to the different tests used to test for HIV. There’s info here about the window period for antibodies and P24 and for accuracy of tests.
So it’s a good idea to look at the window periods for these tests. You can talk to the doctor about the symptoms and decide if you need another confirmatory test.
Hello Roy, i want to asked about hiv? I tested again in January, i tested test hiv 1 and 2 P24 ag Eclia test, how is accuarate and save this test? and it was negativ! But i have all symptoms of hiv, i am very tired, i have rash, alergy joint paints, headche, what does mean this symptoms, please tell me.Thank you very mpuch