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Recent illnesses, vaccinations, viral load/resistance
Nov 13, 2000

Dr. Holodniy,

I contracted HIV 8 months ago, and started d4t, 3tc, and efavirenz 6 months ago. At the time my viral load was 120,000 and CD4 550. The VL decreased by one log after a month of treatment, but was not <50 until two months ago. My latest CD4 was 800 (it had risen to 1100 at one point). I have recently (for the first time in my life) had a perirectal abscess, which was very inflammed, and had to be drained twice, and this week required a formal fistulotomy. I also got my flu and pneumococcus vaccines two weeks ago. Two days after that I got a cold, and now I have a mild sinusitis and bronchitis. Is this the sort of scenario, with an initially high VL that was slow to be suppressed, and recent immune challenges, that VL can creep up and resistance develop? When should I have my viral load rechecked? Do these infections possibly signal viral escape, or just bad luck? Angst in SF

Response from Dr. Holodniy

Dear SF, I think your viral load suppression curve actually looked pretty good and well within the time frame we expect folks to get to < 50. Most of the data on viral load increases has been in people on no therapy, or suboptimal therapy. In anecdotal series in people with viral loads of < 50, there has been little to no increase in viral load. No evidence that I am aware of that resistance develops in people with viral loads < 50 who had an acute infection. I wouldn't check your viral load for at least 4 weeks after you recover from your last illness.

MH



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