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viral load blip related to Herpes

Jan 13, 2013

Dear Doctor Holodniy- First, I want to thank you for your tireless efforts to help us all understand the ongoing issues related to living with HIV. I was diagnosed 2 and a half years ago with a VL at 86,000 and cd4 count of 486. I became undetectable within 6 months and my cd4 count rose dramatically, as well. My most recent labs were done at a different laboratory in a different state altough it is nationally affiliated with a large testing entity. My results showed a VL of 320, CD4 of 1000, %40.8. My cd4 and percentage have never been as high as they are currently. My doctor said it was a blip and not to worry and we will retest in a months time. I have never missed a dose of Atripla; I have recently been suffering from a chest cold which has lasted for over 4 weeks now and was treated with a Z-Pack two weeks ago but it has not completely cleared up;and I suffured a minor bout of shingles in August, 2012 which came and went rather quickly. My doctor suspects herpes as the culprit in my recent blip but is unsure if it would still be lingering after my shingles outbreak from 5 months ago. Is there a herpes test I should be taking to see if I am still in the midst of an outbreak which is causing my VL spike? Is there a herpes treatment (I know it is not curable) I should consider to alleviate what might be causing the blip? Thank you for you consideration.

Response from Dr. Holodniy

Ongoing viral infections can result in an increase in viral load and usually a decrease in CD4 count. This happens mainly in people who are not taking HIV meds. In people on HIV meds and with undetectable viral loads, an elevation could still happen although it tends to be much more blunted. Thus, this could be the case with you. You don't indicate what your CD4 count was when you first became undetectable, and thus, from where it increased to the current level. It would be unlikely to currently be the result of a shingles outbreak from 5 months ago, especially if the lesions have all healed. If there were ongoing lesions (extremely unlikely in someone with a CD4 count of 1000), then this could result in a viral load increase. I think you are too far down the road for antivirals to have any effect on the shingles, which is now back to being dormant.

Hard alcohol consuption and ART
related on the RPR titer 1:16

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