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Why has my viral load decrease slowed
Oct 30, 2010

Hello and thank for your time.

I started treatment on sustiva and truvada on August 16th with a baseline cd4 of 261 16% and a viral load of 28 500. This was the lowest my cd4 has been and the highest my viral load has been in the 2 years Ive been positive and just over a year i've been diagnosed.

After one month my viral load had gone from 28500k to 558 and my cd4 to 497 and 26%. After another month my viral load was at 277 and cd4 at 385 and 35%.

I got my VL over the phone and the health advisor said that while the 2nd result represents a lower than expected decline it is still in the right direction and nothing to worry about. Though he encouraged me to discuss this with my doctor in person next week.

Is it possible to see a steep drop followed by a small drop without some sort of resistance having developed?

Should I have another resistance test next week just in case to ensure if there is resistance that it doesn't get worse?

If I had developed resistance in the last month is it possible for the vl to decrease (even though its a modest reduction) or would we expect it to rebound from 558 to the low thousands?

I have read that it typically takes 3 months to become undetectable but I am concerned that the slowdown is pretty big. Is this the case?

Thank you for your help once more

Response from Dr. Holodniy

Your response has been excellent. It may take a few months to get to undetectable. Your viral load is too low to do a resistance test and it would be likely be unnecessary, as I predict your viral load will be undetectable shortly.



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