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VL Variance
Jun 12, 2000

Dear Mark: I have had two occasions over the past two years where my VL has increased over UD and returned to undetectable. The first time was last March (88) and then last month (55). My CD4 have increased each time and last month was at an all time high of 501 (18%). I am extremely compliant with all of my medications and NEVER miss a dose (Sustiva/Combivir). My physician always discounts any value less than 100. Is that a safe assumption and is that considered normal test error? Thanks for all of your help!

Response from Dr. Holodniy

Most of us are discounting these "blips" as noise in the assay. There is some variability in assay performance. However, they could be the result of intercurrent illnesses, nonadherence (doesn't sound like that in your case), or possibly resistant strains lurking in the background. Some very preliminary data demonstrated the presence of new resistance mutations in the cells of patients who had experienced these blips. I am advising my patients to hold the course and not consider any intensification of treatment until more data is collected to determine if these blips are clinically significant.

MH



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