How Will I Know if My HIV Treatment Regimen Is Working?

In general, viral load is the most important indicator of how well your regimen is working. Your viral load should decrease if your anti-HIV medications are effective. Other factors that can tell you and your doctor how well your regimen is working are:

• Your CD4 count. This should remain stable or go up if your medications are working.
• Your recent health and results of physical examinations. Your treatment regimen should help keep you healthy.

How Often Should I Have a Viral Load Test?

Your viral load should be tested 2 to 8 weeks after you start treatment, then every 3 to 4 months throughout treatment to make sure your anti-HIV medications are still working. HIV treatment should reduce your viral load to the point at which it is undetectable. An undetectable viral load does not mean that your HIV infection is gone; it simply means that the test is not sensitive enough to detect the small amount of HIV left in your blood.

If your viral load is still detectable within 4 to 6 months after starting treatment, you and your doctor should discuss how well you have adhered to your regimen (see What Is Treatment Adherence and Adhering to My HIV Treatment Regimen Fact Sheets). Missing medication doses is the most common reason for treatment failure and development of drug resistance. Your doctor should do a drug resistance test, which will determine if the HIV in your body has mutated into a strain that your current treatment regimen can't control.

How fast or how much your viral load decreases depends on factors other than your treatment regimen. These factors include your baseline viral load and CD4 count, whether you have taken anti-HIV medications before, whether you have HIV-related medical conditions, and how closely you have followed (adhered to) your treatment. Talk with your doctor if you are concerned about the results of your viral load tests.

How Often Should I Have a CD4 Count?

CD4 counts also indicate how well your treatment regimen is working. Your CD4 count should be tested every 3 to 6 months throughout your treatment. HIV treatment should increase your CD4 count or at least keep it from going down. Talk to your doctor if you are concerned about your CD4 counts.

My Doctor Wants to Change My Treatment Regimen. Why?

There are several reasons why you may need to change your treatment regimen. Two of the most important reasons are drug toxicity and regimen failure.

Drug toxicity means that your treatment regimen causes side effects that make it difficult for you to take your medications.

Regimen failure means that the medications are not working well enough (see HIV Treatment Regimen Failure Fact Sheet).

Ask your doctor to explain why you need to change your treatment. If the reason is drug toxicity, your doctor may change one or more of the anti-HIV medications in your regimen. If the reason is regimen failure, your doctor should change all of your medications to ones that you have never taken before. If you have been taking three medications and all three cannot be changed, at least two medications should be changed. Using new medications will reduce the risk of drug resistance. See Changing My HIV Treatment Regimens Fact Sheet for more information about changing treatment regimens.

For More Information

Contact your doctor or an AIDSinfo Health Information Specialist at 1–800–448–0440 or http://aidsinfo.nih.gov.

Terms Used in This Fact Sheet Adherence: how closely you follow, or adhere to, your treatment regimen. This includes taking the correct dose at the correct time as prescribed by your doctor. Baseline: an initial measurement (such as CD4 count or viral load) made before starting therapy and used as a reference point to monitor your HIV infection. CD4 count: CD4 cells, also called T cells or CD4+ T cells, are white blood cells that fight infection. HIV destroys CD4 cells, making it harder for your body to fight infections. A CD4 count is the number of CD4 cells in a sample of blood. Drug resistance: HIV can mutate (change form), resulting in HIV that cannot be controlled with certain medications. Viral load: the amount of HIV in a sample of blood.

This information is based on the U.S. Department of Health and Human Services' Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents (available at http://aidsinfo.nih.gov).