CD4 count and viral load, in plain English

Two numbers come back from the blood tests, and they are usually explained in about forty seconds by someone who says them every day. Here they are slowly.

Viral load: how much virus there is

Measured in copies per millilitre of blood. Before treatment it can be anywhere from a few hundred to several million. A number in the hundreds of thousands looks terrifying written down and is completely ordinary at diagnosis.

This is the number that moves fastest. It falls steeply once treatment starts, and the goal is undetectable, under 20 to 50 depending on the test.

CD4: how your immune system is doing

CD4 cells are the immune cells HIV attacks. The count is how many you have per cubic millimetre of blood. Somewhere around 500 to 1,500 is the usual range for someone without HIV.

Below 200 means the immune system is weakened enough to be vulnerable to infections it would normally handle, and your clinic may add something to protect you while it recovers.

CD4 recovers more slowly than viral load falls. It can take months, sometimes a couple of years, to climb back into the normal range, and it often keeps rising for years. A low count at diagnosis is not a life sentence, it is a starting point.

The first numbers are the worst numbers

Diagnosis catches you at your lowest point, which is precisely why it happened when it did. Almost everybody's numbers look better at the next test than at the first one.

The number that actually predicts how this goes is none of the above. It is whether you take the tablet every day.

Where this comes from

Talkpositive is peer support, not a medical service. Anything about your own treatment belongs with your clinic, and they will not mind you asking.

If you would rather ask someone who has been through it

Talkpositive is a free, private community for people living with HIV. No real name needed, nothing public, nothing in search engines. Small rooms by what you are going through, and quiet one-to-one conversations that open only when both people have said hello.