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Viral load Blip again
Oct 13, 2013

10-09-13 Hi Doctor, this is a follow question, this is what happened since last question, had a VL load test in June 2013 and came back undectectable, but now in 09-13 came back detectable at <42. Have not changed meds, Tcells 860. The only resistance I had was back in 2003 : A71T/V, A71V, D30N, K20R, M36I, N88D.

K103N, K103N/T, K65R, L1001, M184V.

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.

Response from Dr. Holodniy

I think you are in good shape and would not be concerned at this point given the results of your CD4 count and the follow-up viral load. It is confusing regarding the interpretation of viral load results with current generation assays. In the not to distant old days, anything below the cut-off value (i.e., < 42 copies/ml) would have been considered undetectable. Now, the companies are providing qualitative results (present or absent) below the cut-off value, which makes it confusing for many patients and clinicians as to what this means and what to do. Most studies suggest that detectable, but below the quantifiable cut-off level, does not result in HIV treatment failure in the majority of patients.



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