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 everyone.
I was diagnosed with a high viral load of 600,000+ copies and cd4 of 225 aprox.
I am. So scared that due to this extremely high amount of hiv in my blood I will never be undetectable or that I will succumb to other side effects. I suffer from severe anxiety and insomnia due to mental stress and issues which have also popped herpes twice in the last year. Probably due to stress. I’m taking LTD daily and haven’t missed any dose at all. I did an hiv test last year around August which came back negative. And one now in May which is positive which means I had the virus for less than a year. I unfortunately had a terrible pneumonia back in March and I was scared it was because of HIV and because I was told my cd4 is only 225 I though I am a rapid progressor and my inmune system was already damaged. I’d like to know if I will be OK? I know my vl has to go down as I’m taking an integrase medicine and cd4 should go up regardless of stress and anxiety but I just would like some comfort to sleep well and to know I’ll be alright or at least my hiv will be under control. Additionally, do you think suffering from anxiety and mental issues decreases cd4 count or will the medicine always work if I take it daily as prescribed? Thanks everyone
Hi Dani,
I’m sorry to hear about your recent diagnosis. But it’s good that you started HIV treatment (ART) staight away. Biktarvy is safe and effective. It can reduce your viral load very quickly.
But what did your doctor mean about being a fast progressor? Please ask them and let us know.
What was your viral load when you tested HIV positive? Please let us know this too.
Hi, I’m Dani I was diagnosed with HIV May 29, 2020 my cd4 count at the time was 199. They prescribed me Biktarvy. I went back to recently to do labs and my viral load is now 402. They stated I was a fast progressor. Still not undetectable but almost there. It depends on your body.
Hi Giovanni,
I can’t say if Biktarvy is the right choice for you or not. It is however, like all ARVs effective at controlling a persons HIV. I hope that this decision was made between you and your consultant.
Given that your CD4 is very low, the important thing is that you’re taking ARVs.
Hello I’m Giovanni I’m 41 yrs old and I was diagnosed HIV positive march 3rd of 2020 I started ART (Biktarvy)on april 1 2020 I was told my cd4 count was at a 29 I was wondering how effective Biktarvy is for me and if I made the right choice
Hi Mathew,
You’re going great, your HIV is 100% under control. Your viral load is undetectable and your CD4 is at a god level, well done.
Hi
I was diagnosed in October 2018 and cd4 was 173 when I started taking meds..
I had blood samples again in October 2019 and cd4 was 539 with a viral load of >20
Is the progress slow or normal since it’s difficult to discuss with the nurses because they are forever in a hurry due to abnormal queues…
Hi Mark,
What does the doctor say about your results? Are you on HIV treatment (ART)?
Your viral load is low but not undetectable at below 50 copies/mL. A CD4 count of 122 cells is low and means your immune system might not be able to fight other infections.
What HIV meds you’re taking, and when did you start ART? And how are you feeling? Please let us know.
My viral load is 100 copies/ml and 122 cells/ul. What does this mean?
Hi Peace,
TDL (tenofovir/dolutegravir/lamivudine) can dramtically reduce viral load in the first few days by 90%. And by 99% within the first few weeks. So it’s good that you started HIV treatment in February.
Many people become undetectable within a month. And most within three months.
Do you have access to your viral load and CD4 counts? Please let us know what the latest results are.