Thanks for your question and the chance to post a reply online.<\/p>\n
While CD4 results are the most important test before starting treatment, viral load results are more important once you are on-treatment.<\/p>\n
Viral load usually drops very quickly when you start treatment – sometimes by 1 log in the first few days, and by another log in the next week or two.<\/p>\n
A minimum response you should expect is to have at least a one log drop after 4 weeks treatment.<\/p>\n
A ‘log’ is a factor of 10. For your figures, this means viral load could have dropped from 90,000 to 9,000 in the first week, and down to 900 within the first few weeks.<\/p>\n
These are average results though, and there is a lot of variation between different people. Also, most clinics only check the effect of treatment after the first 2-4 weeks. Although you don’t get results on the very early effect it is good to know what is happening.<\/p>\n
Most guidelines suggest that most people should become undetectable within 3 months. If your first combination includes and integrase inhibitor, most people become undetectable within one month.<\/p>\n
If viral load starts at higher levels (i.e. over 1 million), it may take a bit longer, especially if your started treatment in very early infection.<\/p>\n
CD4 counts are generally more slow to respond – and this is a good thing. If anything, getting a very rapid CD4 increase can sometimes be linked to complications, especially if you start with a low CD4 count (under 200 or under 100 etc).<\/p>\n
As long as your CD4 count is above 200, there is little chance of any HIV-related complications, and the higher it goes, it is generally better.<\/p>\n
For some people, this may never get much above 300 – but this is still good enough to keep them healthy for many years. Others may go past 600, and sometimes over 1000 – though there has not been any research that shows any specific benefits from very high levels in people when on treatment.<\/p>\n
The idea of a ‘normal’ CD4 count is difficult – for some people this could be 400, for others it could be 1400. In practice, no-one has a CD4 count result from before they caught HIV – so knowing what is normal for any individualat best just a guess. As long as your counts starts to go up, how high it goes, and how fast it does it, isn’t something to worry too much about.<\/p>\n
Keeping over 200-300 is the first goal and then aiming for >500.<\/p>\n
It is very good that you have started treatment. Your count could rise by 10-20 a month or more. It should only be a worry if nothing happens, or if it starts to fall, and this can happen in a small percentage of people.<\/p>\n
This answer was updated in January 2019 from a question first published in May 2007.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Hi there<\/p>\n I have recently been started by consultant on the combination of Truvada (tenofovir+FTC) and Sustiva (efavirenz), following results which showed my CD4 at 259 and viral load of around 90,000.<\/p>\n This was my second blood test. The first test, two months earlier, showed CD4 of 360 and viral load of 70,000, so my consultant felt we should start on HAART.<\/p>\n My question is, on my combination:<\/p>\n How quickly should my CD4 and Viral Load return to ‘normal’ ie when will \t get undetectable viral load, and when will my CD4 begin to rise?<\/p>\n Hope you can help.<\/p>\n Many thanks<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,9,39],"tags":[],"class_list":["post-107","post","type-post","status-publish","format-standard","hentry","category-all-topics","category-cd4-and-viral-load","category-starting-treatment"],"_links":{"self":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/107","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/comments?post=107"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/107\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/media?parent=107"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/categories?post=107"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/tags?post=107"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}