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1 year ART, still detectable viral load?

Jun 23, 2013

Dear Dr. Holodniy, Please help clarify my little concern here. I am a healthcare professional who is Positive and I am on ART for more than a year now (14months) with Atripla for 5 months (before were Truvada+EFV). My initial Viral load was more than 3 millions and Cd4 count was just 12 cells or 1%. The cd4 count was raised to 545 in 9 months 14% and Viral load was 145 copies. My recent lab result after 14 months ART yeild that my viral load is still detectable at 68 copies/ml or 1.85 log and my cd4 count drops a bit to 515 but %CD4 rises to 17%.

Is this something acceptable or I should be worried? I had no resistance drug genotype test done while on the treatment. My doctor is very kind, cool and very reliable and I'm sure he will tell me not to worry and I would agree with him as I am pretty healthy now but I just want to hear your opinion. Please have a look on my case. Thank you very much Sir

Response from Dr. Holodniy

I worry more when the viral load has never become undetectable and remains in the low positive range, than when the viral load was undetectable and now blips to some low level like yours. In general, given the very high viral load you had before starting HIV treatment, it takes longer for the viral load to become undetectable. By longer, I mean 6 months after starting treatment. 14 months after starting and still with a consistently positive viral load would make me think about adding and HIV med or two to get the viral load to undetectable, after which you could back off the additional meds. There is no denying that you have had a fabulous response to treatment. But prolonged HIV treatment in the face of ongoing viral replication can lead to viral resistance. Unfortunately, your viral load is too low to get a resistance test, so it is hard to know whether viral resistance is in the picture at this point or not. Even though you did not have a viral resistance test performed before starting treatment, my guess is that you didn't have any, otherwise we would have seen a rebound in viral load earlier in the course.

Moderate CD4 count, but still low %
Low level viremia despite treatment

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