Your Guide to HIV Treatment

Monitoring your health

“My GP [general practitioner] is a compassionate doctor who spends extra time listening and talking to me, as he knows I’ve struggled with depression. He’s there to help and support me.”

—Randy

Regular visits with your doctor to monitor your health are part of living with HIV. At these visits, you can ask questions and talk about any changes in your body that you may be experiencing. Your doctor may do a physical exam to follow up on specific issues.

You will also get blood drawn at the lab every few months, particularly in the first year of treatment. Your blood will be tested for several things. Two important blood tests will be done to measure your viral load and your CD4 count. Other routine tests can spot potential health issues even if you have no noticeable symptoms.

How you’re feeling – Every time you see your doctor, tell him or her how you have been feeling, especially if you have noticed anything new or unusual. This can also include changes in your mood and mental health: If you’ve been feeling down or depressed, say so. Your doctor will probably follow up with some questions.

Your viral load – Your viral load is the amount of HIV in your blood. A viral load test measures the amount of HIV in a sample of blood. The results are reported as the number of copies of HIV genetic material (called RNA) in a millilitre of blood (copies/ml—a millilitre is about the size of a pea). Without treatment, a person’s viral load can be as high as millions of copies/ml.

“I feel good when I get that undetectable result every three months. It’s always the first thing I ask my doctor about. It means that I don’t have to change my treatment and that everything is fine until the next time I get my viral load checked. It’s encouraging, a positive affirmation that I’m doing well. I have multiple drug resistance, so not having to change my regimen is a great relief.”

—Murray

The standard tests in Canada can measure levels as low as 40 to 50 copies/ml. Below this level, your virus is considered undetectable. (There are more sensitive viral load tests, but these are used only in specialized labs and in some clinical trials.)

Your viral load is the most important measure of whether or not your treatment is working. The main goal of treatment is to reach an undetectable viral load as soon as possible and to keep it that way.

An “undetectable” viral load does not mean that there is no HIV in your body. It means that the amount of HIV in your blood is too low to measure using routinely available tests. If you miss doses, stop taking your treatment or if the HIV in your body becomes resistant to your antiretroviral drugs, your viral load will once again become detectable (that is, greater than 40 or 50 copies/ml). In this case, you may need to change your treatment.

Your CD4 count – Your CD4 count is one measure of how strong your immune system is—that is, how well you are able to fight off infections. CD4 counts generally drop as HIV does more damage to your immune system and they go up as your immune system regains its strength with treatment.

A normal CD4 count in a healthy HIV-negative person is generally somewhere between 500 and 1,500 cells. The sooner you start treatment, the more likely your CD4 count is to stay high or increase to a high level.

Generally, you should get your CD4 count checked every three to six months. CD4 counts are measured in cells per cubic millimetre (cells/mm3—a cubic millimetre is about the size of a pinhead).

Resource

HIV viral load testing – CATIE fact sheet