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Looking at CD4 and viral load together
If you’re not currently taking anti-HIV threatment, your viral load and CD4 cell count can help predict your risk of becoming ill because of HIV in the future.
Among people with the same CD4 cell counts, research has shown that those with a higher viral load tend to develop symptoms more quickly than those with a lower viral load.
In addition, among people with the same viral load, those with lower CD4 cell counts tend to become ill more quickly.
As the table in the section 'Why monitor?' earlier in this chapter shows, looked at together, your CD4 cell count and viral load provide an indication of your risk of developing AIDS in the short to medium term.
For example, if you look at the column for people with a CD4 cell count between 351 and 500 you can see that there is a big variation in the risk of disease progression, depending on the level of viral load.
Deciding when to start treatment
Your viral load and CD4 cell count can help you decide if you need to start taking anti-HIV treatment.
At the moment, doctors put more emphasis on the level of your CD4 cell count, and it is recommended that you start treatment before your CD4 cell count falls below 200. This is because your risk of death is greater if you start treatment when your CD4 cell count is below 200.
At higher CD4 cell counts, the picture is much less clear, and your decision will depend on a combination of the level of your viral load, the speed at which your CD4 cell count is falling, any symptoms you may have, and your wishes.
The question of when to start HIV treatment is looked at in a lot more detail in the chapter Anti-HIV treatment.
Monitoring the effectiveness of treatment
Effective anti-HIV treatment results in a fall in your viral load. Within about four weeks of starting HIV treatment, your doctor should test your viral load to see how much it has fallen.
The aim of treatment in people who have never taken anti-HIV drugs before is to get viral load to undetectable levels within 24 weeks.
As your viral load falls, your CD4 cell count should begin to slowly increase.