I was diagnosed in April and started medication in June. My viral load when I started meds (Isentress and Truvada) was 690,000 and my CD4 count was 154. It was a relatively new infection and while my doctor wanted me to wait and see if I bounced back I decided on treatment. 4 weeks later I was tested and my viral load was 296 (over a 3 log drop) and my CD4 was 300. At the 8 week mark I was tested and my VL was 128 and CD4 278. An added factor was at the time of the 8-week test I was right in the middle of a herpes outbreak on my lip.

My question is since I made almost staggering progress in 4 weeks, shouldn't I have been undetectable at the 8-week mark? Is there anything to worry about? My doctor thinks the trends are in the right direction and the herpes infection could have inflated my VL and the CD4 was just normal fluctuation.

Thanks for your question and congratulations on the great response.

This trend is perfectly fine and expected.

The virus level in the blood comes from various sources: The vast majority comes from "activated" CD4 cells that turn over very quickly and spew out lots of virus...these also get snuffed out quickly on treatment. This accounts for the rapid first phase of drop in viral load (it is like dousing the flames on a fire). A lesser amount of virus comes from "resting" CD4 cells that turn over more slowly, and lastly from long-lived memory CD4 cells that turn over even more slowly. This is like the embers that remain from the fire. These also have their virus production suppressed but since they grow more slowly it hangs around longer. Starting from over 500,000 viral load it may take 12-16 weeks to get undetectable.

Keep up the good work.

Joe