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. Dudu • 20 November 2018

   I’m having a a problem was away for a week and I forgot my medication at home and I wasn’t taking them and I’m back and im taking them Am I going to get sick

2. Roy Trevelion • 13 November 2018

   Hi Patience,

   Tenolam E is a similar to Atripla. All HIV meds (ARVs) reduce viral load very qucikly once you start taking them. As Simon says here, that can be as much as 90% in the first few days.

   But getting to undetectable can depend on how high your viral load was when you first started. But guidelines here in the UK expect to get to undetectable within 3 months.

3. Patience • 13 November 2018

   Hello i have started taking tenolam E since 25 09 18 how long will it take for my viral load to be undetactable .i always take it on time.

4. Lisa Thorley • 19 October 2018

   Hi Jay,

   Thanks for the positive feedback. Its great that you find the sight helpful. I’m going to answer your Q’s in order:
   1- For how your meds should ideally be taken, please see here: http://i-base.info/guides/1561
   2- No this won’t have any influence on your meds.
   3- As long as you adhere to your meds and they are the right meds for you then they should be working. Ideally a persons viral load should be undetectable within 1-3 months, however this can take longer. Mine for example took 6 months, and that’s even when my viral load wasn’t that high. This is why its important to have your viral load tested.
   4-Please see Q 13 here: https://i-base.info/qa/what-are-the-most-asked-questions
   5- Yes you can have a drink, this isn’t a problem.

5. Jay • 19 October 2018

   Hello. I am so delighted to come across your page this morning which has helped me and with all honesty I have learnt allot reading several replies to comments. Kudos to the i base team however I have few questions.

   I usually do my regular test every 6 month. In November 2017, I was HIV Negative but was Positive in July 2018 due to my careless having 1 unprotected sex. I was placed on the following medication – efavirenz 600mg/lamivudine 300mg/tenofovir disoproxil fumarate 300 mg which i usually use one tablet at night (10:30pm) daily with Septrin to build my immune system.My doctor also gave me TB medication to prevent me for having it for the next 2 years. My CD4 was 322 but my viral load was given to me. I have been very faithful with my medication and never for once missed my doze (10:30pm daily but occassionally 9:45pm if I am so tired and want to sleep). I dont have serious symptoms apart from the first 2 days of taking my medication in July (Dizziness at night) but all gone now.

   My questions are:
   1. Can I eat around 9:30pm before using my medication (efavirenz 600mg/lamivudine 300mg/tenofovir disoproxil fumarate 300 mg)? Will these affect my medication?. I read some report stating it should be taken on an empty stomach. Please advice as I am confused and want to be undetectable when I go for my next test in 3 month time.

   2. I usually take garlic, ginger and onions (all blended) in the morning. Will it affect my ARV medication at night?

   3. According to UK and US records, a patient get undetectable within 3 month. Should I be worried my viral load will shoot up considering the fact i take my medication. What other factors stops medication from not working?.

   4. Can I take multivitamins as well in the morning to help my immune system with the Septrin the doctor gave me.

   5. Can I take alcohol drink once in a while. Maybe once a week

   Please advice. I really want to become undetectable and continue my medication till a cure is found.

6. Roy Trevelion • 9 October 2018

   Hi Sani,

   Atripla is a safe and effective drug for HIV.

   However, it’s usual for CD4 counts to go up and down. It looks as though your CD4 count is fairly stable and within the ‘normal’ range. But you can ask for your CD4% as this can show whether there’s a real change in immune function. Please see here.

   You can talk to your doctor again about why they think your treatment might not be working. And is it possible to have the viral load test result before the 25th?

7. Sani • 9 October 2018

   Sorry about the confusion I’m on Atripla. My cd4 count have been going up and down. Before I started medication My Cd4 was 514 then it dropped to 398 then the last test I took it was as 504. My viral load has been dropping but at a slow rate. It was at 24,000 copies before but its now at 5,000 copies when I tested 3 months ago.

8. Roy Trevelion • 8 October 2018

   Hi Sani,
   Sorry, this sounds confusing. What meds are you taking?

   But you can try talking to the doctor who thinks the treatment isn’t working. You can also ask them what other HIV meds are available to you in Nigeria.

   It’s a good idea too to ask about your previous CD4 counts to see if your immune system is recovering.

9. Sani • 8 October 2018

   Hello. So I the first time I started my medication after 3 months my viral load was about 24,000. They didn’t check my viral load before I commenced treatment. The next time I checked my viral load it was around 9,000 and now its down to about 5,000. The problem is that the viral load is dropping but not at a fast rate as I am supposed to be undetectable because I have been on ARV treatment for 2 years now and have only missed my medication once. I took another viral load test recently and the result should be out by my next doctors appointment on the 25th of this month. I just want to know what’s your expert opinion on this and what I can do. Cause one of the doctors think I’m failing the medication while the other suggests that since its dropping I should stick to it. Because another reason is that since I’m In Nigeria there isn’t much options for me

10. Lisa Thorley • 5 October 2018

    Hi Victor,

    When you say timings what do you mean? Are you skipping meds? If you are this could be the reason why your viral load is still detectable. However, your viral load could be like this if the meds that you’re taking aren’t the right meds for you. This is something that you’ll need to talk to your doctor about as you may need to change.