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Assay Variation or Treatment Failure?
Aug 10, 2008

Hello Dr. Holodniy! I have been positive for 7 years, and my viral load has been <50 until about one year ago. My last five, 3-month checkups have shown a fluctuation in viral load from 50 to 773 (773 was my most recent test result, about 2 weeks ago). I'm still on my first treatment regimen which I started immediately 7 years ago of Sustiva & Epzicom. I meet with my doctor on Aug. 12 to discuss the most recent lab results. (By-the-way my CD4 count has been consistently between 700-1800 over the last 7 years). Should I be concerned that resistance may have developed? Is there anything I should make sure my doctor discusses with me or should do for me when I meet with on Aug. 12?

Response from Dr. Holodniy

A viral load of 773 makes me a bit nervous as to what might be going on. First thing to do is repeat those numbers. If the viral load is consistent at this level or higher, then you know, that some resistance to one or all of your current medications may have happened. A resistance test would be in order to sort this out. Although assay variability at that level is possible, the viral load usually doesn't go that high. If on the other hand the viral load is back down, no worries.



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