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not achieving to get fully undetectable overtime

Aug 19, 2017

Hi,

Main reason of this post is to have a second opnion. Leaving with HIV for almost a year, I still can't manage to get fully undetectable. I'm a bit concerned whether it can be a case of therapy failure.

Below my questions :

1) I got HIV through my partner who didn't know he was poz with a very high viral load, hence very infectious.

We always had safe sex, but in one occasion condom got broken, and I decided to take PEP, after asking him to be tested. I begun PEP 24 hours after this high risk exposure (though I may have been exposed to HIV through previous oral intercourse with him, as he had a decayed tooth with heavy bleeding from time to time)

After taking PEP for over a month, no matter what, I turned to be positive 2 months after stopping PEP (all my previous test were negative but last one was indeterminate, and turned out to be positive eventually).

My question is : PEP not working eventually for me and stopping treatment for over 4 months, may have induced some resistances?

(I got diagnosed positive October, and started treatment Truvada + Tivicay /Dolutegravir one month later)

2) My viral load was very high by the time I got infected, over 3 Millions, though I successfully managed to lower it to 100 copies in 2 months and half of treatment by mid February of this year ( one month treatment on Truvada + Tivicay /Dolutegravir, one pill regimen on Triumeq, which I'm still taking, thereafter)

My concern is that my viral load didn't succeed to get under 100 copies ever since

(Febr . 98 - April : 117 - June : 102)

Is it normal to have such a massive drop to a very low viral load, but then remaining stable without achieving full undetectablity?

Should I wait more time to get fully undetectable? Can it jeopardize my health general condition on medium/long term?

My health care provider requested some resistance tests, and suggested I might have to switch to Genvoya (Cobicistat boosted).

3) In case I switch to new meds, like Cobicitats boosted regimen, as suggested by my doctor, or any other meds, how long should it take to get fully undetectable?

With such a low viral load as 100 copies presently, should I wait again 3 more months to see if the new treatment works, or some effective medicine should allow me to get undetectable in a month or so? (so I don't have to wait so much time again in case i have to switch treatment)

4) according to PARTNER studies, and other medical research, with a stable 100 copies viral load, am I able to still transmit the virus? The odds should be the same than someone with under 50 copies.

Thank you so much for your time and consideration,

J.

Response from Dr. Holodniy

You don't indicate whether a HIV resistance test was performed before you started treatment. I assume not and your viral load response would suggest that your virus strain was not resistant to the HIV drugs you have been on. Transmitted resistance virus is still rare, there have been some Prep failures, but resistance associated with ongoing Prep use is even more rare. Sometimes we do see this kind of stalling out and might require some modification to the HIV regimen. Your HIV viral load it too low to get a standard HIV resistance test. The only test that could be performed is a GenoSure Archive test, which looks at the HIV strains inside blood cells and not in the plasma. That could be helpful in ruling in or out resistance mutations associated with any of the HIV drugs you are on. Now you could wait and just see what the retest viral load result looks like before doing anything in terms of changing HIV meds. The change your doctor suggested is a reasonable one, either now or if you wait. Risk of transmission is always difficult to quantify. It is certainly very low, but I cannot say zero.



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