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CD4 vs Viral Load

Mar 5, 2017

When I tested positive (four years ago)I was almost dead. CD4 was down to nothing, Viral Load was up to 700,000. With Atripla the situation reversed. Presently, my CD4 count stays around 450 (a vast improvement from when I started meds); the viral load had been <20 for two year, taking ATRIPLA. Then in August it began to rise slightly to 37. On Nov 1, switched to Triumeq. Viral load increased to 250 and has remained there since (taking monthly lab tests). CD4 stays in the 450 range. CD4% is about 13 or 14% consistantly. Have checked lab technique ... same tech same equipment. Taking meds properly. What could be causing the increase in VL without a matching decrease in CD4 or significant fluctuation in CD8?

Response from Dr. Holodniy

Two things to think about are HIV drug resistance or drug interactions between your HIV meds and any other meds you might be taking, which could result in decreased blood levels of the HIV meds. Regarding resistance, the HIV viral load is too low for a standard test to determine if your virus has developed resistance to either the drugs in Atripla or Triumeq. Two of the drugs in each combination are similar and cross-resistance is possible. This could result in your current regimen not having 3 active drugs to control the virus. Another test that is available is called the GenoSure Archive test. This test looks for HIV drug resistance inside the blood cells, and is detectable even when the viral load in blood is undetectable or too low for a conventional resistance test. If resistance mutations were found with this test, it could shed light on why the viral load remains detectable.



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