Question

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.

301 comments

1. busi • 13 January 2018

   Hi my name Is busi I started med last year Sept it’s going to be a 6th month now nd my CD for was 332 wen I was starting med nd my husband tested neg his viral load is lower than dedected CD for is above 1000 nd everything Is fine by his side nd my self I’m adhering to the RX no missing doses nd he want us to have baby nd I’m afraid what if my viral load I undidectade nd I can pass the virus to the unborn baby plz help.

2. Lisa Thorley • 2 December 2017

   Hi Ardy,

   If you want to have kids, then you’ll need to be on ARVs. Given that your CD4 is also 329 you should also be on meds for your own health. Once on meds and your viral load becomes undetectable you won’t be able to transmit HIV to your partner. As to when you try for a baby, this is something that you need to decide. Having a stable viral load, is however a good thing.

3. Ardy • 2 December 2017

   Hi I was advised to take arv’ s but m delaying due to work conditions to go and do Pap Smear,,my cd4 was 329 that was blood results on August 2017 and had dermatitis on my head which I got anti-biotics from GP ,but recently I have been suffering from boils on my back thigh and disappearing on their own,,same with my man and we want to have a baby next year,,we are both 38 years this year….if I start treatment on Dec or Jan 2018 with him will we be able to try for a bby normally without protection after 3or 4 months?

4. Lisa Thorley • 19 November 2017

   Hi Terri,

   How much weight have you lost? What was your CD4 count when you started meds?

5. Terri • 19 November 2017

   Will I gain my lost weight back after starting treatment?

6. Lisa Thorley • 10 November 2017

   Hi Ntobeko,

   If your viral load is increasing when you’re adhering to your medication, then yes you will need to change. This is because a persons viral load can only be kept under control if their are on a ART combination that works for them. Though this may be scary, there are lots of other combinations available to people who are positive. For more info about viral rebound and changing meds, please see here:

   http://i-base.info/guides/changing

7. Ntobeko • 10 November 2017

   Please help , I have been taking ARVS for over 3years but my viral load is increasing monthly and they suggests that I should charge Atroiza but I don’t want to do that please help what should I do to decrease my viral load without changing to onother treatment

8. Lisa Thorley • 8 November 2017

   Hi Emmanuel,

   I’m happy to hear that the service we provide is helpful.

   Resistance is usually caused by not adhering to your ARVs. Though it can also develop even if you do adhere to you meds. This is why its important to have tests done that show what you may or may not be possibly resistant to.

9. Emmanuel • 8 November 2017

   Hi Lisa

   Thank you for you kind response, you guys are really saving souls. Most times reading through your post keeps my spirit up. Thank you once again.

   I have been on MED for exactly 33 days now. Hope the combination of my HIV drug is okay. Apart from missing of your doses what else can cause resistance thou I am doing my very best never to miss any of my dose.

   Also I started having hot boils thou just like 4 spot which have also disappeared on its own.

10. Lisa Thorley • 8 November 2017

    Hi Emmanuel,

    Once your viral load becomes undetectable there’s no reason why you can’t have children the normal way. This is because once undetectable you can’t transmit HIV. For more info about this, please see here:

    http://i-base.info/htb/32308

    With regards to the weight loss, this could be due to many things of which stress is just one cause.