Jun 23, 2002
I have posted questions here before and have always derived strength and hope from the answers I have received. Yesterday I received some rather devastating news. I was diagnosed in Sept of 2000. Since that time my viral loads have hovered in the area of between 8k and 1k, with the highest blip being 24k during a viral infection. My tcells have averaged between 350 and 580 with the percentages steady at 30. My last viral load test in Sept of 2001, was 1100. The last few labs that have been run have been screwed up by the local lab, who lost blood vials, neglected to spin them, etc. This last reading absolutely horrified me. My tcells were 484 with a percentage/ratio of 28 and a viral load of 62000. I have been inconsolable. I thought I had things under control. I just took my dream job as a personnel director of a county gov't agency. Just bought a brand new car. Is this a turning point? Is the virus rebelling against my defenses? Are meds in the near future? I had hoped to defer as long as possible. I am so terrified that I can't concentrate. Please give me your evaluation. I live in a rural area and dropped my I.D. Specialist for unprofessional and unethical behavior. I have to now wait three months for an appointment with HIV Specialist 45 miles away. I don't think I can wait that long for any advice. I would appreciate whatever insight you can offer. Thank you for all that you do. You and this website are a godsend.
Response from Dr. Young
Thanks for your question and comments.
Firstly, I don't think that it is reasonable at all to wait three months to do something about a viral load of 62000 following previous suppression. Delayed intervention could place you at risk for developing high levels of drug resistance, and most importantly the development of cross resistance to other drugs that you have never taken (indeed, the very drugs that you might be counting on using for your second line therapy).
I'd assert strongly that you need to have at least repeat viral load testing (to confirm that you are having increased viral loads), consider strongly obtaining a drug susceptibility test (genotype or phenotype-- I usually use the former in this case). Once that data is available, making some sort of adjustment to the therapy is highly recommended.
Changing therapy has many options, from stopping therapy, intensification (adding one or more drugs), or complete switching. Which approach is best for you would depend a lot on what options are available and what type of drug resistance pattern that your virus has (hence the importance of knowing your lab tests).
As for your long-term prognosis; I don't think that the future is gloomy, but will definately require some introspection to figure out why you've had a treatment failure (?missed doses, wrong medications, dietary issues with certain drugs, for example). Second line therapies can have performance that is as good as first line therapies, if constructed appropriately and adhered to well. I'd try to advise you that there is no need to be terrified, rather, I'd work to be proactive in getting the relevant data and asking your doctor to get appropriate, timely counsel (if that doesn't happen, feel free to write us back-- maybe we can help through the net). Either way, three months is too long to intervene.
Hope this is helpful. Good luck and stay in touch. -BY
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