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New Viral Load Testing in Australia
May 13, 2012

Hi from Australia Dr Mark.

Thanks for your informative answers on this forum. I was informed at my last 4-monthly lab tests that viral load testing in Australia now measures down to 20 copies/ml, whereas previously it was 40 copies/ml.

How does this affect being "undetectable?"

I have been undetectable for 5 years now every test and in good health. Prior to now, this obviously meant my copies/ml were under 40 copies/ml.

Not that they measure down to 20 copies/ml, does this mean that, say, I had labs come back with 26 copies/ml I'm not undetectable, whereas with the previous tests I would have been undetectable? Would this be a cause to worry or think that my treatment is failing?

In other words, where do we draw a line between treatment success and failure now that the tests are so much more precise than before? What is the amount of copies/ml where I would need to be concerned?

I hope this makes sense, and thanks in advance for your answer. Regards, Australian Guy.

Response from Dr. Holodniy

We have been operating under the assumption for years that being undetectable below 40-50 copies was considered successful treatment. Now we have more sensitive assays and all of a sudden many people are now "detectable" and concerned about what that means. There is significant controversy around what these newer assays with lower levels of detection limits mean. The published data on this is controversial, with some studies showing a higher likelihood of treatment failure and many showing that it is not. Some experts think you should have have no detectable viral load (i.e. below 1 copy) in order to have successful treatment and other experts do not. Several studies have also been published looking at the question of whether adding additional HIV drugs helps reduce the viral load further. In general, the answer is no. I would not be concerned and do not think your treatment is failing. Consistent trends where the viral load is above 200-500 are likely signs of failure and where HIV treatment changes likely should be made.



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