Question
How quickly does viral load drop on treatment?
5 July 2020. Related: All topics, CD4 and viral load, Starting treatment.
I’ve been trying to understand on average, the daily rate of decrease in viral load following initial treatment.
I’m guessing that this changes over time and varies from case to case according to the chosen treatment, CD4 count and viral load level and possibly other factors.
However, supposing that the viral load is around 100,000, the CD4 count is around 400 and the treatment used is Atripla, could anyone please let me know the expected % decrease of viral load level per day at least within the 1st month of treatment?
Thank you for the help.
Answer
All HIV combinations (ART) starts working from the first dose.
Viral load is usually reduced by 90% (also referred to as 1 log) within the first few days. It then continues to fall but not as quickly (see below) until it becomes undetectable.
A log is a number mulitplied to the power of 10. So with a viral load of 100,000 copies/mL, a 1-log reduction would bring your viral load down to 10,000 copies/mL and a 3-log reduction would reduce it to 100 copies/mL. (See this factsheet).
You are right that individual factors will lead to difference rates of viral load reductions. These include:
- How high your viral load was when you start ART.
- The medicines in the combination (integrase inhibitors casuing the fastest drops).
- The drug levels of this meds (related to adherence and how they absorb and processes drugs).
- Good adherence – not missing doses.
UK and US guidelines recommend that your viral load should be undetectable within three months. However, many people achieve this within the first month, especailly if they are using an integrase inhibitor.
Some people take longer, especially if their viral load is very high when they start treatment.
Lots of studies have reported detailed early responses ART, including for efavirenz-based combinations like Atripla.
This decline is often referred to as having three main phases.
The first phase is very rapid – referred to in some studies as being the first few days and in others as within the first two weeks. This is where the actively infected CD4 cells are targeted. CD4 cells infected with HIV only live for a few days and when you start treatment this virus and these cells are quickly reduced.
This results in a viral load drop of perhaps 99% (2 logs) within two weeks.
The second phase, out to the first month is slower, as it is working on cells that live longer. This can easily reduce viral by another 90% (another 1 log reduction). In people with very high viral loads when they start treatment, this second phase may continue for longer until viral load becomes undetectable.
Some researchers also talk about a third phase decline which occurs even more slowly and gradually once your viral load is undetectable.
This relates to a reduction in the levels of infected CD4 cells that are latent (or resting). This pool of cells only slowly decreases over time.
This link is to an early study describing the two-phase viral load reductions.
This answer was updated in July 2020 from a question first posted on 15 September 2012.
Hi
I was diagnosed last month On the 31st and started taking Treatment a week after on the 7th my CD4 count was at 879. The first week of treatment I had no side effects at all but this second week I am truly struggling. Could I be doing something wrong perhaps?
Hi Lebo,
You aren’t in trouble, however it does sound like you’ll need to change meds. This is something that can be done usually quit easily. For more info, please see here:
http://i-base.info/guides/changing
I’ve just received my results today, my viral load is 2480, The nurse told me that it is high and that I’m in danger. I’ve been on meds for 4 years.
Hi Thabisile,
Most side effects go within a few weeks. However, for some people they may last a lot longer. If your meds are really causing you problems you should discuss this with your doctor.
just started on a fixed dose efv,tdf&emtricitabine am almost 2 weeks now but i still feel dizzy and nauseous is this normal?
Hi Dudu,
If you been taking your meds are prescribed there’s a possibility that the tests might be wrong, or that you may have developed a form of resistance to the meds that you’ve been taking. Therefore, this is something that you need to talk to your doctor about as you might need to change.
Hi
Am on ARV’s for 2years now, all along virus was lower than detected. I recently went to the doctor for my 6 months bloods. The results are back, viral load is less than 100 but again my CD4 count is also low 350 but before it was 940.
Hi Lanre,
Info about ARV’s can be found here:
http://i-base.info/guides/starting
ARV’s in most countries are free. If you tell me where you live, I’ll be able to tell you if you have to pay for them or not.
The only thing that can control your HIV is ARVs. Supplements can’t really help. A good diet is important for everyone.
My question is what is the cost in three categories of treatments for one who just get to know he is HIV positive and the best form of treatment that will not require every day drug but that will require some months drug after which regular eating of balanced diet and some food supplement is need.thank you
Hi Sisie,
I can’t comment on the colour of your sisters stools. However, her being on meds is the best thing that she can do. More so given that her CD4 is low. Is she also taking co-trixmoxazole? For more info about low CD4s please see here:
https://i-base.info/qa/4643