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Detectable Viral Load last 2 test
May 5, 2013

Dear Doctor,

Poz since 1997, have been on numerous combos and have some resistance, was on Kaletra, Combivir, Viread and on this combo for 6 years and undetectable, tcells at about 800. Made a change August 2012 to Isentress, Prezista Norvir, 1st VL in 10-2012 Undetectable, Tcells 725. but the last tests came back detectable in 03-13 VL 97, tcells 877, and my last test on 04-27-13 VL 48. I feel extremely concerned of having detectable VL with these new medications, maybe it's not enough meds for someone with prior resistance, should we add something? Thank you for your comments

Response from Dr. Holodniy

Perhaps. Not knowing your previous resistance results, and your viral load is too low to get a resistance test at this point, it is hard to know whether this is just insignificant blipping or something to be concerned about. It is interesting that you were taking Kaletra and 3 NRTIs (combivir and viread) and were stable, and then dropping the NRTIs for an integrase inhibitor now possibly changed the equation. It would be unlikely that you had integrase resistance before starting. I don't know whether you had any protease inhibitor resistance before that could be affecting the prezista activity. The isentress should be more than enough to make up for the 3 NRTI's you were taking previously, particularly if you did not have any resistance to them. I wouldn't do anything yet and get another test or two to see where the trend is going. But I have found that sometimes you have to add an NRTI back to mix if you are not getting the desired effect.



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