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Ongoing Low Level Viral Replication

Jan 23, 2011

Thank you for your excellent forum.

I'm a 44 year old male who began treatment with a CD4 of 199 nearly four years ago. I have had KS, but thankfully, the lesions have all faded and no new ones have appeared since about a two years ago through HARRT-only therapy.

Until the last five months, I've been undetectable since about the first month of treatment and my CD4 percentage has risen from a nadir of about 18 to 23. My last labs show that my CD4 count is at an all-time high of 560, which is great news.

The issue is that since September, my viral load has shown as detectable at 70 (September), 120 (October) and 148 (January).

The fact that this has persisted for five months makes it seem like it isn't a blip, even though the numbers are so low and as I understand it not statistically different from each other.

Would you advise adding another drug at this time (e.g., Isentress) to my Atripla to get the viral load below 50? Or do I have to wait it out to see if viral breakthrough occurs and the VL is sufficiently high enough to conduct a resistance test, or is there another option I'm not considering?

Thanks for any advice you might have.

Response from Dr. Holodniy

Great question. Many experts would advocate doing nothing and holding the course. Others might suggest (as you did) starting something in addition to your current regimen (like isentress) or change the complete regimen to something else to get the viral load to undetectable and perhaps back off the additional drug when the viral load has been undetectable for a few tests. I am in the former camp and would like to see how the trend continues before I would make any changes.

how to avoid starting taking meds and keep a high CD4 level

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