What's happening?

What exactly does HIV do when it gets inside your body? When you first become infected, your body starts to produce antibodies to fight it off.

You may feel ill for a while at this stage. This is often called 'seroconversion illness' because it coincides with the time that blood tests for antibodies to HIV become positive.

Once seroconversion has taken place, you may stay well for a number of years without treatment. But there will be some signs of damage being done to your immune system. And you are infectious during this period, even though you may not be aware you have HIV.

This damage can be detected by laboratory tests. Doctors will use two key tests at your regular clinic appointments:

CD4 cell count

This gives a rough indication of the strength of your immune system.

A normal CD4 cell count in an HIV-negative man is between 400 and 1600 per cubic millimetre of blood (but doctors normally just give a figure, e.g. 500). CD4 cell counts in HIV-negative women tend to be a little higher, between 500 and 1700.

Soon after infection with HIV, your CD4 cell count probably dropped sharply, before stabilising at around 500 to 600. Even while you are well and have no obvious symptoms of HIV, millions of CD4 cells are infected by HIV and lost every day, and millions more are produced to replace them. General illness can also impact upon your CD4 count, which may subsequently rise again.

It is estimated, however, that without treatment, most HIV-positive people’s CD4 cell count drops by about 45 cells every six months, with greater falls experienced by people with higher CD4 cell counts.

Viral load test

This shows how active HIV is in your body.

The test for viral load measures how many particles of HIV are circulating in the blood. The results are given as the number of ‘copies’ of HIV per millilitre of blood; for example 200 copies/ml.

Your viral loads can fluctuate a lot if you’re not taking HIV treatment. Looking at the trend over a number of months may be more useful than comparing two test results.

CD4 and viral load

A high viral load will usually – but not always – mean a low CD4 count. Knowing what is going on with your immune system can help you make decisions about lifestyle and treatment.

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The Information Standard: Certified member

This article was last reviewed
on 19/1/2011 by T. Kelaart

Date due for the next review: 19/1/2012

Content Author: S. Corkery (NAM)

Current Owner: S. Corkery (NAM)

More information:

Stages of HIV infection, NAMLIFE

CD4 cell counts, NAMLIFE

Viral load, NAMLIFE

The immune system and HIV, NAM aidsmap (2011)

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Your comments (6)

I have been ill for months with sero conversion. My viral count was as high as 1.9million. and I felt dreadful. It has now reduced to 800,000 with a CD4 count of 390. I am still symptomatic with the lastest nfection being oral thrush
Posted 15:30 Wed 24 Aug 2011 by kikker123
Having been diagnosed in Sept 10, having gone through seroconversion in the preceding June. Being married and 57 years old I was put on medication 3months ago with a Cd4 of about 500 and viral load at about 180. I now have CD4 of 974 and my viral load has been 40 or less for the last 2 months. I believe if you get the offer of treatment start as soon as you can. The biggest problem is deciding to start - you won't regret it - ...remembering to take them can prove difficult, but I've a real gem of a wife, who has stuck by me....and got it well organized!
Posted 00:05 Fri 14 Oct 2011 by bossman
I am on Atripla and have been since April 2010. My CD4 did rise to 600 but seems to average at about 400-550 and my vial load is now undetectable. I have had few nasty chest infections and shingles but am otherwise ok :-) To anyone recently diagnosed and ill, keep your chin up- things do get better if you have 100% meds adherence.
Posted 14:38 Tue 29 Nov 2011 by marcsouth
yes i know
Posted 23:31 Fri 10 Feb 2012 by Naiksuk
Having been rush into hospital through stress and exhuastion in March 2010, I was diagnosed as suffering from Severe Encyphlitus to the extent off unable to see or walk, I was also informed I was HIV+ with a CD4 of 53...all being new to me I ignored this for personal reasons..I was put on a drip for the Encyphlitus and also for the HIV, its now febuary 2012 with taking Atripla daily pm and also Cotrimoxazole daily AM. Thus far my CD4 is now 222 & Viral Load undetectable but still confused with this as even though undetectable my CD4 has remained stagnent at 222 but going from weekly to monthly hospital appointments I am now going 6 monthly as Consultant more than happy with progress since admission in March 2010 However, I am isolated and still at a loss in understanding HIV and related symptoms but consultant happy with me and my vast mprovement through personal problems and tragedy and stress to have pulled through yet I am still at a loss. With weight loss & bumps n lumps through weight loss stress & panic sets in whenever I find a lump or a bump but have been told thats normal, depression isolation and all the thoughts etc etc that comes with it I am told is normal, does anyone have the same symptons or problems? share please knowledge is important but vital.
Posted 20:03 Wed 15 Feb 2012 by seankevin
Hi Sean

If you log into your account and go the Community Forums link you'll get the chance to chat to lots of other HIV positive people who may have experienced the same symptoms you have and can offer you some support.

Regards

The web team
Posted 11:29 Thu 16 Feb 2012 by thtstaff