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Women and HIV Viral Load

May 2013

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When Should You Be Tested?

The US treatment guidelines also provide recommendations on when to have viral load tests:

  • If you are not on HIV treatment, have a viral load test

    • When you start receiving HIV care
    • Repeat test every three to four months
  • When you start treatment, have a viral load test

    • When starting and two to eight weeks after treatment was started
    • Repeat test every one to two months until viral load becomes undetectable
  • Once you are on a stable treatment regimen and undetectable, have a viral load test

    • Every three to six months
  • When you change HIV drugs, have a viral load test

    • When changing and two to eight weeks after treatment was changed
    • Repeat test every one to two months until viral load becomes undetectable

If your drug regimen is working, your viral load should become undetectable within six months of starting treatment. If this does not happen, if your viral load stays detectable on stable therapy, or if your viral load keeps increasing, this can mean that your regimen is not controlling HIV as well as it should. It is important that you and your health care provider discuss all possible reasons (e.g., problems with drug absorption, adherence, drug resistance, drug interaction with other drugs) and take steps to correct the problem. These steps may include additional testing and considering changing HIV drugs.

Women and Viral Load


Our understanding of viral load has grown since 1996, when the first viral load test was approved and began to be widely used. Most early clinical trials that studied the role of viral load looked primarily at groups of men. Women were not enrolled in enough numbers in these trials for anyone to know whether there were sex-based differences in viral load.

Since 1996, a number of studies have compared viral load levels between groups of men and women. Some of these studies have found sex differences in viral load. At similar CD4 cell counts, women tend to have lower viral load levels than men. The differences seem greatest during the early course of HIV infection.

When women and men with the same viral loads are compared, women's HIV disease generally progresses faster. In other words, women may develop AIDS at lower viral load levels than men with similar CD4 counts. This may be a reason for women to start treatment earlier than men. However, evidence is not strong enough for it to be included in the US treatment guidelines and recommendations for starting HIV treatment are the same for men and women.

One recent study (March 2013) found that HIV lives and multiplies more often in the fluids in the female genital tract than in semen (cum), even when the person is on effective HIV drugs that show an undetectable viral load in the blood. The authors of the study thought that the female genital tract might be a 'reservoir' or place where HIV continues to live and reproduce despite effective HIV therapy. Researchers are not sure yet why this is, or what consequences it has, but the good news is that it does not seem to affect the chances of spreading HIV. Staying on your HIV drugs and maintaining an undetectable viral load is still the best way to prevent spreading HIV to others.

If you are thinking about starting or switching treatment, it is important to take into account your viral load, CD4 cell count, other labs results, and how you are feeling. Talk to your health care provider about the best treatment plan for you. The good news is that the differences in viral load do not seem to affect how well women respond to treatment.

Areas of Future Viral Load Research

Researchers have noticed that viral load and the level of certain HIV drugs go up and down during the course of a single menstrual cycle. This could have an impact on drug dosing and the timing of viral load tests in women.

Understanding more about sex differences in viral load will lead to better care for HIV+ women. In the meantime, following the US treatment guidelines for viral load testing is an important way for you and your health care provider to check your HIV infection, see how you are responding to HIV treatment, and work together to keep you healthy.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
See Also
What Did You Expect While You Were Expecting?
HIV/AIDS Resource Center for Women
More on How HIV Is Different in Women


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