How to Tell if Your Treatment Is Working

In a Capsule If your treatment is successful, your viral load should drop to an undetectable level and stay there; your CD4 count should increase, although you may not see dramatic increases immediately; the side effects should be manageable; and you should be able to follow your pill-taking schedule. If your viral load does not drop, your CD4 count does not increase, the side effects you experience are unmanageable or you cannot stick to your pill-taking schedule, you and your doctor will need to assess why your combination is not working.

Once you've started your treatment, you'll want to evaluate two things: how well the treatment is doing its job, and how well you're dealing with the treatment.

The first question -- how well your treatment is working -- depends on test results. Successful treatment should accomplish two things: it should bring down your viral load to an undetectable level and it should increase your CD4 count. Depending on how high your viral load was to start with, it should become undetectable, usually within three to four months. A viral load that doesn't become undetectable immediately isn't necessarily cause for alarm: ask your doctor how long it could take in your case. If your viral load is still detectable after several months, you and your doctor will need to look at why this is. Your virus may be resistant to one or more of the drugs, a drug interaction may have escaped notice, or you may be having trouble sticking to your pill-taking schedule.

Once your viral load becomes undetectable, it should stay there. Some people, however, do see occasional blips in their viral load. (A "blip" is when your viral load becomes detectable at a very low level on one test and then becomes undetectable again on the next test.) Among other reasons, "blips" may occur if you're fighting an infection or have recently been vaccinated. If your viral load becomes detectable, your doctor will probably measure it again. A single blip may not be cause for alarm, but two detectable measurements in a row are probably a sign that your treatment is no longer working (see "Changing Medications Due to Side Effects").

Increases in CD4 counts don't usually happen as quickly as drops in viral load, so don't worry too much if your CD4 count doesn't skyrocket the way you had hoped. Once HIV is successfully suppressed, your immune system should rally. Unfortunately, people who have started treatment with low CD4 counts are likely to see the most modest increases in counts.

If the results of your viral load and CD4 tests show that your treatment is working, an equally important question is: How are you doing? Has your health improved? How are the side effects? Are you managing to take your pills as prescribed every day?

Let's look at some of the common issues that may arise once you've started taking antiretroviral medications.