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Why can't I achieve Undectable V.L.?

Jan 18, 2009

I was infected in 1987 with HIV. Not having faith in the meds at that time, and due to depression, I've only been adherant since spring of 2006. On 12/06 my V.L. was 55,900 & T-Cells @ 297. Hence on 01/07 I was switched from Reyataz, Norvir & Truvada to Prezista, Invirase, Norvir Truvada. Then in 5/07 I was Undectable with 472 T-Cells. My next test three months later, my V.L. spiked (or bliped?), up to 5,510 and T-Cells @ 300. After taking a phenogeno test, my V.L. was under 1,000 so no change in meds was needed. Then three months later I was undectable again with my T-Cells @ 315. My Dr. said the reason for the rollercoaster year (WITHOUT!,.. a change in meds!), was due to dental infections, but it is only a theory. Then in 2008 the lowest my V.L. got, was 51 (3 points shy of undectable! ARG!!!). and the higest V.L. was 167. My T-Cells averaged 333 in 2008 (except for one spike of V.L. to 956, & T-Cells @ 290, again blaming the spike on an absess in my tooth). I was unable to achieve an undectable V.L. in 2008, it hovers around 100. However in 2007 I WAS able to achieve an undectable V.L. in two out of my four tests for that year. Keeping in mind all of these spikes came back in control, WITHOUT, changing HIV meds!!! My Dr. calls me an enigma & can't explain why I cannot get my V.L. down to undectable. My recent labs, on 12/08 were 99 V.L. & T-Cells @ 384. I have two questions,.. 1) Can secondary infections cause the V.L.'s to spike, to then come back under control after a secondary infection is handled via antibotics, WITHOUT, changing HIV meds? 2) Why can't I achieve Undectable V.L.'s presently?,...why does my V.L. seem to hover around 100? This rollercoaster ride has had a traumatic affect on my Mental Health, because I'm now resistant to 95% of availible HIV meds & I panic when I have to wait a month to get test results, to find out if I'm out of the "Loop," of available meds!!! Thank you and Aloha!

Response from Dr. Holodniy

To answer your questions: 1. Yes. 2. You don't state what the resistance test results in 07 showed. So it is hard for me to comment on whether that regimen truly has 100% or partial activity and could be accounting for why you can't quite get to undetectable. You further state that your virus is resistant to 95% of meds. Was this a new resistance test or from the results in 2007? It may require a modification in your regimen, say modify the truvada, discontinue the invirase and and start raltegravir (the new integrase inhibitor).

MTB PCR negative MTB Ig M positive possible?
Chronic Pain (All Over)

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