Question:

I want to know how much does your viral load go up before you know you are dying? When you first get HIV what does your viral load start at to where the doctor can detect you have HIV?

My doctor told me that I am now in the AIDS stage and the more I am stressed, the more my viral load goes up. She took me off my meds to see which one keeps making me sick, was she suppose to do that? The meds I was taking were Combivir, Norvir, Levita (I think that's how you say the last one).

I just need to know if I am closer to dying or living...

Answer provided by:

Rodger MacArthur, M.D.
Wayne State University
Division of Infectious Diseases

The HIV viral load (HIV RNA) is a measure of how much virus there is per milliliter of blood. The higher the viral load, the more pressure HIV exerts on the immune system (especially the helper T-cell, or CD4+ cell), and the faster the CD4+ cell count falls. It is the low CD4+ count that puts an individual at risk for the infections and other opportunistic events (such as lymphoma, a cancer of the lymph nodes) that are associated with AIDS. Individuals with CD4+ cell counts less than 100 cells per microliter are at increased risk for getting one of these conditions; those persons with CD4+ cell counts less than 50 cells per microliter are at extremely high risk for getting and dying of one of these conditions within 3 years. In the absence of treatment with antiretrovirals (HAART), a person with a CD4+ cell count of 25 has about a 2.5 year life expectancy.

While HIV RNA levels are often very high late in the course of HIV infection, high viral loads can be seen at all stages of infection with HIV. It is the CD4+ cell count that more directly determines the stage of the infection (AIDS, for example). The lower the CD4+ cell count, especially for counts less than 200 cells per microliter, the greater is the risk of dying within the next 3 to 5 years. Life's stresses (such as losing a job) do not have an effect on HIV RNA level, but a high HIV RNA level does put more killing pressure ("stress") on the immune system.

For persons with CD4+ cell counts less than 200 per microliter, it has been shown to be risky to stop HIV medications. Stopping HIV medications in such individuals is associated with an increase in HIV RNA levels, a decrease in CD4+ cell counts, and an increase in clinical events, such as thrush. If antiretroviral medications must be stopped because of side effects or allergic reactions, it is advisable to stop all antiretrovirals at once. Stopping all antiretrovirals at once decreases the chance of resistance developing to the remaining medications. However, because these medications last in the body for variable periods of time, even stopping all of the medications at once does not completely prevent resistance from occurring. It often is better to try to treat the side effects of these medications while continuing to take them, rather than stopping them.

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