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viral load all over the map

Mar 7, 2010

hi there - thank you all so much for your time and energy with these q/a''s an incredible resource for all of us seeking some second/third (even first)-hand advice...

i was diagnosed in january of 2009, conversion happening around july of 2008. my first tests (these are off the top of my head because i don't have my labs close at hand for the moment) were CD4 650ish, 29% VL: 30,000 - and as follows every three months: CD4 536 27% VL 37,000 - CD4 600 31% VL 40,000 - CD4 530 29% VL 60,000 - CD4 715 27% VL 23,000 - and most recently: CD4 640 29% VL 86,000...

i know that 86,000 is high for a viral load...and i see that the general trend is one that is moving upward and approaching a level of necessary medication. but my doctor is not very stressed about it, and mentions the log all the time, that the change in viral load is not hugely noticeable when talking logs, etc...i think he's great at bringing my stress levels down after getting each test result, but at the same time, i want to be realistic. i would love to hold off on meds as long as i can, but i don't really have anything against starting them, and have always said that i'd rather start out of choice than out of necessity. my CD4s are obviously taking the beating pretty well - they're consistently pretty strong and mostly above 600 except a couple of times. my % stays around the 29-ish range, which isn't terrible. it's the viral load that i don't like the looks of. besides saying, "time to start thinking about meds," what other kind of advice/tips/reactions would you have to this trend of test results? how does one explain such a drastic drop to 23,000 after a seemingly-consistent trend upward (and now suddenly a "drastic" jump to 86,000)? why such changes? i have friends whose levels are consistent throughout, little change...what explains such a lack of stability in the viral load? are these things explainable?

thank you!

Response from Dr. Holodniy

In general, I agree with your doctor's assessment and your own assessment of what's going on. I am not sure I am willing to consider the one 86,000 value a trend, given the prior test was 23,000 and the average is about 35,000 overall. Meds are definitely in your future but I don't think it's urgent at this time.

HIV and Pulmonary hypertension
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