How can someone really determine their viral setpoint?For example I waited four years after infection to treat, because although I wasen't experiencing any hiv related side effects the vl bumped up from it's normal level and I was concerned of cd4's slipping too much(they were still near 500).So can I assume my setpoint was the number right before i began meds? Also when an sti is started with a high cd4 count after years of therapy will the vl spike rapidly then settle back down or will it slowly rise.how long off treatment does it take to get a spike and would any symptoms be present that would represent a spiking load?Thank you

As long as there were no acute illnesses going on, then I would consider the pretreatment viral load as the "setpoint". In most people this will be a relatively stable number after 6 months of infection. After STI, the viral load can overshoot the baseline (setpoint), reach the setpoint or not get to the setpoint.