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Sudden increase in VL

Nov 13, 2011

I've been on sustiva and epzicom for 7 yrs. for past 6 1/2 yrs my vl has been undetectable and cd4 has ranged from 500 to 1,000. My most recent labs came back with vl of 45,000, cd4 is 950. My doc said he assumed I missed doses. That's not the case though. I've only missed aprox 10 in 7 years, and only 1 at a time. My doc said he couldn't explain it. He assured me not to worry as there are plenty of options. Only odd thing I can think of was that I was on Medrol steroids for a week, and gabapentin and naproxen for 30 days for a herniated disc 3 months ago. Could there have been a drug interaction? Is a sudden increase in vl like this strange given near 100 pct compliance?

Response from Dr. Holodniy

I agree this is very unusual given your several year track record of undetectable viral loads. Medrol could be the culprit here. Steroids can turn on and turn off all sorts of things in the immune system. An increase in viral load associated with steroid use has been reported sporadically in the literature, but usually in those people not already on HIV meds. I don't think other drugs are involved. I would just wait until your next regularly scheduled visit and have it repeated. It it persists, then resistance may be greater possibility and your meds would have to be adjusted. If it is back to undetectable than you have the likely explanation and nothing further needs to be done.

Low cd4 count

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