Treatment training manual

1. 8 How quickly does HIV progress without ART?

Without treatment (ART), HIV will steadily become more advanced. This happens at different rates in different people.

The graph below shows three rates for the CD4 count could drop without ART.

HIV progression in different people

Becoming more ill in early infection is a risk for faster progression.

There is no test to know how quickly HIV will progress.

But ART works well for everyone. In 2021, there is no reason to delay ART, so the speed of progression is not really used.

Time for CD4 count to drop to 200 (without ART).

Before ART, these rough times were reported.

  • 25% people would take 1-2 years (fast progressors).
  • 50% people would take 2-10 years.
  • 25% people would 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 people early diagnosis is more common if you have symptoms.

Link to UK Seroconvertors Study.

Time between infection and the need to start treatment

In 2021 nearly all guidelines 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 2021.