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new to hiv and labs concerned VL
Feb 22, 2004

I was diagnosed HIV poz or to be more accurate with AIDS in January 2003 with a cd4 of 50 viral 750000 and PCP. Went in the hospital and started treat of combivir and sustiva. April 03 labs cd4 367 viral load less than 400. August Labs cd4 404 viral 175. November labs cd4 385 viral 352( three weeks prior to these labs had a Hep B booster, started Hep A vacination and had a flu shot). Doc not concerned at this point possibly a blip or reaction to vaccinations. My labs as of yesterday cd4 452 viral up to 746 (prior to this lab was at the tail end of a bad cold). My question: Should I be concerned that I am not staying undectable with viral load even though cd4 is up. Could this be early warning that my first med regime is not working or I am becomeing resistant or could being vacinated and sick with a cold result in a spike in vl. I am just so new to the world of hiv and labs and understand them that I am not sure what I should or what questions to ask my doc next week.

Any advice or assistance would be great thanks

Response from Dr. Holodniy

Your question is a good one. I am a little concerned about the trend. A blip is usually just that, going from undetectable (< 50 copies/ml) to some low but detectable number (usually < 500) and then usually back to undetectable again. Your trend is somewhat different, being consistently detectable. You are correct to raise the issues of ongoing infections and vaccination, which could be contributing to this observation. You have had a great CD4 count response, and appear to be maintaining that inspite of the nagging detectable viral load. Depending on when and where you were infected, transmitted resistant virus to at least one of the meds you are on is a very real possibility. It usually requires at least a viral load of 1,000 in order to get a resistance test done. If on the next labs, you are not ill, and the viral load is still elevated or higher, a resistance test is in order. In cases such as yours, there is a high likelihood of 3TC resistance (in the combivir), followed by sustiva resistance, because it only takes one mutation in the virus to lose activity for each of those drugs. It then becomes crucial to know which you can keep and which you will need to change, if resistance is the issue.



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