Is a High Viral Load Dangerous?

Dear Christine,

I just came back from a doctor who destroyed whatever confidence I thought I had by telling me my viral load is over 750,000. He said I will die of pneumonia within six months if I don’t start the meds immediately. He also said that even though my T cells are at a decent level right now (590), they are not going to last long with such a high viral load.

The thing is, I am not sick at all. I just got back from a three week hiking trip across Nepal. Unlike me, almost everyone on the tour was a super athlete, but I was one of the only people who didn’t have diarrhea the whole time or get high-altitude sickness.

Should I believe these numbers? I’ve been positive for eight years, going along just fine, and have never taken meds. I hadn’t been to an AIDS doctor in seven years before getting all this bad news.


Dear Help,

Take a deep breath. Viral load numbers are not reliable indicators of health or accurate predictors of illness. Although these tests were approved as prognostics (to aid in foretelling a future outcome), the data upon which approval was based shows they are about as reliable for prognosticating illness in people who test HIV positive as flipping a coin.

In the studies that secured FDA approval for the viral load test, 60% of patients with the lowest loads “progressed to disease,” while 50% of those with the highest numbers also “progressed to disease.” If anything, we would expect to see the slightly higher percentage of “progressors” among those with the highest loads, not the lowest.

With the odds for a coin toss at 50-50, flipping a dime to predict your future health would be almost as reliable as a trip to the doctor—and save you about $400!

There is no strict correlation proved to exist between viral loads, T cells and health. High viral loads persist in the presence of high T cells, low viral loads are found in people with low T cells, and health outcomes frequently defy prognoses based on either of these tests. Also, HIV negative people may register viral loads or have T cell counts lower than that required for an AIDS diagnosis.

Rather than going to a doctor who measures health by the numbers, you might want to see one who will see you more objectively and use other diagnostics and information to assess your actual state of health.

Stay calm,


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