HIV and Viral Load

[PozDaddy916]

I tested positive for HIV in May with a viral load of 6.8 million and a CD4 of 375 

That is very high. My dr says that since I was negative for HIV in March it was a recent exposure and that’s why it was so high

Any of you poz men experience high viral loads like that ? 

[Hairypiglet]

It is rather common for recent seroconversions to have a huge surge in VL and drop in cd4 that balances out within a few a months and then proceeds to steadily shift back to an HVL and low cd4 over the course of years until AIDs and eventually death.

[fskn]

I want to point out for others who might find this thread in the future that the standard of care in the US is now same-day initiation of antiretroviral therapy, for newly-diagnosed HIV positive people who decide that they want to take medications. A person who tests positive should leave the medical office with a starter pack of HIV drugs (and a follow-up appointment to review the initially chosen regimen).

Coupled with frequent state-of-the-art testing (4th-generation HIV antibody/antigen tests, or pooled qualitative PCR HIV viral load tests for people at high risk), same-day ART significantly shortens the time to viral suppression.

As @Hairypiglet points out, a drastic spike in viral load is expected after infection. Then, viral load drops (though without treatment, not to an undetectable level) and life continues normally for years (even in the absence of treatment).

An unarrested initial spike in viral load followed by no, or slower-than-necessary, viral suppression, will not harm the infected person at first. But the wisdom in the field of "cure research" (really, research into achieving long-term viral suppression without frequent medication) is that speeding up viral suppression has long-term health benefits. First, it reduces the burden of inflammation in the body. Second, it limits the "viral reservoir" (virus that isn't killed by HIV treatment, and doesn't replicate, but that resumes replicating the moment treatment stops). If "cure research" continues to advance, people with a smaller viral reservoir will have an advantage.

The truth is that some practitioners still aren't offering frequent, state-of-the-art testing, and that few practitioners are willing and able to provide same-day ART when someone tests positive. You will find these high levels of care in San Francisco (where a "Getting to Zero" committee sets policy for all providers, citywide) and possibly in a few other major US cities.

If you are at risk of getting HIV, and the issues I've mentioned are important to you, talk with your medical provider about the type of HIV test you are receiving, the frequency of testing, and whether your provider is willing and able to offer same-day ART if you do test positive. Your quality of life in the long-term could depend on where you live and on who provides your HIV prevention/treatment care.

Edited June 19, 2021 by fskn
typo