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Infrequent VL Testing
Mar 23, 2014

Hi, I have been diagnosed since 2007 and not yet on meds. My clinic decided to stop testing my VL at 3 month intervals, I was then being tested at 4 monthly visits as my CD4 count has been above the 500 mark since diagnosis, however, my VL has been all over the place ranging from 10,000 to 169,000 during this time. More recently, my clinic have decided to only test my VL every 8 months, so once a year effectively. There has been no explanation as to the reason for this decision, and when I asked why, I was informed it was owing to cost. Naturally, I am concerned about this, as whilst my CD4 is above 500, it is systematically reducing at each test and my VL has shown increases. My question is, in relation to clinic guidance, should this be happening when we know my VL is still extremely volatile? Shouldn't VL be considered as a marker for disease progression alongside my CD4? I am considering raising this with the health regulators as I feel that my welfare as a patient is coming second to efficiency savings within the NHS. My own health and wellbeing is important to me, and I feel that this decision will affect my healthcare provider's, in addition to my own ability to know how my body is coping with the virus. I feel that one test per year is pointless in knowing how much virus is circulating in my blood during the rest of the year. Any feedback would be helpful. Thank you.

Response from Dr. Holodniy

Assuming you are in the UK, you might want to consult the BHIV guidelines: http://www.bhiva.org/TreatmentofHIV1_2012.aspx. The guidelines for when to start treatment reflect CD4 count thresholds and not HIV viral load results. So, although not optimal, your doctors are probably reacting to what the guidelines say and that is what the NHS has adopted.



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