Treatment training manual

1. 8 How quickly does HIV progress without ART?

Without treatment (ART), HIV steadily becomes more advanced.

This happens at different rates in different people.

The graph below shows three examples of how the CD4 count can drop without ART. These are for fast, average and slow progressers.

HIV progression in different people

There is no test to know how quickly HIV will progress. This can sometimes be estimated by the history of someone’s risk, with results from a special HIV test. This modified test is called a recency test or a de-tuned HIV test (also sometimes called RITA or STARHS).

A more serious illness in the weeks after infection is a risk for faster progression.

But ART works well for everyone.

In 2023, there is no reason to delay ART, so the speed of progression in an individual is often never known.

How long does the CD4 count take to drop to 200 (without ART)

The following rough times are estimates for how quickly HIV progresses if you are not on ART.

  • 1 in 4 people (25%) take 1-2 years (fast progressers).
  • 2 in 4 people (50%) take 2-10 years.
  • 1 in 4 people (25%) take 10-15 years.
  • Less than 1% people would still have a high CD4 count after 15 years. These people were called long term slow progressors (LTSPs). Even more rarely, some people not only keep a strong CD4 count, but they also keep an undetectable viral load. These people are called elite controllers. (Viral load is discussed in the next chapter).

These results are based on a UK study from 2008. It was in people who were diagnosed during seroconversion. Everyone in the study was then followed over time (without ART). These results may overestimate progression because early diagnosis is more common if you have symptoms.

Link to results from the UK register of seroconverters.

Time between infection and the need to start treatment

In 2023, all guidelines should recommend ART at any CD4 count.

This means that CD4 monitoring without ART is rare.

  • Most people now start ART soon after they are diagnosed.
  • Many doctors give you ART in the same week, or even on the same day.

Last updated: 1 January 2023.