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Not sure what to do

Oct 5, 2013

I'm 32- tested positive three years ago. My CD4s were right around 200. My VL was about 50,000. About two years ago, I switched to Atriplia after being on Kaletra and Truvada. It seemed to work great and I remained undetectable for about 18 months. My CD4 went up to about 400 but have usually been in the 300's. Since then, I've put on healthy weight and feel good. I was dangerously underweight but am now within a normal healthy range. Then- about 9 months ago, my VL increased to 150. We thought it was a blip. Last test, six months ago, it came down to 130. Then, three months ago, it was down to 120. It bothers me that it's detectable, but it's trending in the right direction. Unfortunately, in the last test my CD4s were down to 290. That is still within +/- 100 of where I've been at, but it has been pretty dang stubborn and this is the lowest in over two years. My adherence is perfect. I have a great doctor who is obviously somewhat concerned. I've been pushing really hard in the past couple of weeks to add an additional ARV to nip this in the butt and hopefully get back to undetectable and see my CD4 count increase. Frankly, I'm a little terrified and just want to deal with this. The doctor's office called today and is suggesting doing a few more labs and going on another ARV on top of Atriplia. So a few quick questions- is it better just to do this and get back to undetectable, or will there be bad side effects (I've never had any before)? Is there anything I can do to increase my CD4s? (Ironically, I've quit smoking six months ago and now exercise regularly, and eat healthy food- and my numbers are now worse than when I smoked a pack a day and sat around!). I know I worry too much, and I have the type of personality that would compel me to do labs everyday if I could (okay, that's a slight exaggeration). That said, putting off getting tested initially (out of fear) and what I went through then taught me that the key to living a full, healthy life is to deal with everything immediately. Is it better to hold off on any new drugs or just go for it?

Response from Dr. Holodniy

A repeatedly low positive viral load is likely real and not a blip or assay variability issue. Your viral load is too low to get resistance testing done in order to see whether your virus has developed resistance to any of the drugs in Atripla. I would agree with a modification of your HIV treatment regimen to get your viral load back to undetectable. Although there is always the potential for side effects, there are many options available.

Undetectable viral load, strong CD4: how often should I get labwork done?
My Achy Breaky HAART

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