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.
If i am hiv positive and i am taking my treatment very well and im having undetectable viral load does tht mean i can pass medical test? How will the companies know tht m hiv bt my viral load is undetectable? Or will they draw blood and send them to the lab, or once thy see I test HIV positive they will declare me unfit. I’m asking bcz i have applied for traffic officer job and a fire fighting leadership in South Africa, i need a clearance?
Hi Grace, As Lisa says here, nigella seeds are not going to help with your treatment. But you can eat seeds and honey as part of your diet. But it sounds like your ARVs are not working. Has the doctor recommended second line treatment because your first drugs are not working well? You can ask about your viral load results since starting ARVs. Changing to second line drugs can help viral load to go down.
Hie,
Can blackseed and honey works while taking ARVs? coz my viral load is still going up though am taking drugs in time, and am afraid to start second line though doctor said we should wait till next test.
Hi Mimi,
It does sound like things are going well. That’s great, and congratulations on having a baby. It says in the i-Base guide to HIV and pregnancy that, ‘The benefits of ART are not just to your own health. Treating your HIV will reduce the risk of your baby becoming HIV positive to almost zero.’ You can read more about looking after your health, and your baby’s health in this guide.
You can ask at the clinic for support during your pregnancy and for when the baby is born.
Hi, before I started the meds my VL was 270 000 copies in November 17 and when I found out I was expecting I had to start taking Art, did a follow up test last month now my VL is 273 copies. I take it that things are going well.
Hi Remmy,
What medication where you taking before the change in medication? Do you know why it was changed? What blood tests have you been having if you don’t know your viral load?
Hi, for me I’ve been on treatment for almost two years now. I don’t even know if my viral load has reduced or undetected? Sometime ago, they changed my medication to another type. Does this means I’m getting better? It’s really weighing me down. Each time I have an appointment with them, is all about blood test and maybe my medications.
Hi Mbali,
What medication are you taking now? Is it the same as what you were taking when you’ve previously stopped meds?
If your viral load is increasing, even if you’re adhering to your medication, this is a sign that the meds aren’t working. Even if the clinic aren’t being helpful, its important that you talk to someone who is able to make decisions. What is your relationship like with your doctor?
Ideally when someones viral load rebounds, resistance tests should be done.These allow doctors to see how your body is reacting to the medication. There’s more about this here, as well as what to expect when changing meds:
http://i-base.info/htb/33092
Please let us know how you get on.
Hi I stared my treatment in 2012. I was not taking my medication properly. In 2015 i stopped for 8 months. I restarted my medication and ever since been on the right track. My problem now is that my viral load seems to be increasing instead of decreasing. What could be the problem and what can i do or steps to take because at clinic there keep on taking my blood every time i come there instead of getting me help. My viral load is at 20 000 and I’m afraid now.
Hi Busi, being on meds is good for you and makes it easy if you want to have a baby. The same meds will protect your baby too. If your husband is HIV negative, he doesn’t need to test his CD4 count and viral load. Please talk to your HIV doctor about your plans so they can help. There is lot more info in this online guide:
http://i-base.info/guides/pregnancy