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Question about different viral load methods
May 20, 2006

I had to change doctors due to the insurance of my new job not accepting this doctor. I have been undetectable since starting meds with the exception of a few blips. However, my old doctor used the ultrasensitive method, which can detect as low as 50 copies. This doctor uses the method that can detect as low as 400 copies. I have a few questions regarding this.

How well can a doctor compare previous history with two different methods being used? I haven't been the best at taking my medicine consistently, so if I theoretically am between 50 and 400 copies--which would still qualify as undetectable on this method, but not on the other, would this viral load increase be significant? I realize it is still low if that hypothetical situation is the true case, but is it necessary to remain undetecable while on meds? And should I worry if I was consistently below 50, but now am between 50 and 400? Thanks for your time.

Response from Dr. Holodniy

An age old debate about viral load assays. You are asking all the right questions. Many experts consider viral loads of 51-400, in those with currently undetectable viral loads (< 50), to be blips suggestive of assay variability and not treatment failure. However, in those who never got to undetectable and are stuck in the low positive range, this is a very different situation and suggests low level ongoing replication. In most people who fail a regimen because of the development of resistance, it will go from < 50 to some number higher than 400 relatively quickly. The goal is to remain < 50. If it were to remain consistently between 51 and 400, then it is more likely that low level ongoing replication is taking place and again resistance to HIV meds is possible.



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