Consistant low level viremia
Jun 1, 2014
Hi, I was diagnosed in November 2012 with a CD4 293 and VL 83000. Immediately started Atripla and quickly went undetectable and remained there for several months before it started creaping up slowly. Finally at around 700, medication was switched to Dolutegravir and Truvada. This combination also seems to not be working as my VL is fluctuating between 400 - 1000. I have been on this new combo for 3 months. However my CD4 has continued to increase, now around 900.
My Dr seems puzzled, as numerous resistance tests show no mutations. I am very physically fit, going to the gym every day lifting weights, I do not drink, do not smoke, , no drug use, and I have taken my medication as prescribed never missing a dose. She is also surprise that I have not developed mutations after having a detectable VL for nearly a year now.
After consulting with her colleagues, my Dr thinks that maybe I have a hidden reservoir that is still pumping out the virus that meds cannot get to. She offered two options, adding Prezista, or trying twice daily Dolutegravir. I chose twice daily Dolutegravir since I am currently on it and tolerate it well. If after a month, it hasn't brought me undetectable, then I reluctantly will add Prezista.
My main concern is that I initially had a great attitude about my future and having HIV, knowing that I could live a normal healthy life. But now it seems that I may not be able to control the virus for whatever reason. I am really concerned what this can mean for long term survival.
I would appreciate your thoughts on whether or not you have seen this, meaning someone not having mutations, but also not being able to suppress the virus completely. Also, insight on how to get it to undetectable, instead of having a consistent low level viremia.
Response from Dr. Holodniy
It was good you got the resistance tests done. I assume that included a resistance for dolutegravir. Some resistance tests do not include the integrase gene. I agree with adding the Prezista as the next step. From what you describe, the resistance test did not show any resistance to protease inhibitors, so Prezista (darunavir) should be a maximal potency.
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