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DR. Wohl....I'm freaking now

Oct 23, 2002

Dear Dr. Wohl, Help! I'm on a treatment interuption (doctor sanctioned) and having my first labs drawn in the next week or so.In a response to a question posed to you regarding if some one could stop therapy after reaching a certain vl level, you likened antiviral therapy to birth control and said that once the drugs are removed the vl with spiral back to it's high within days.I was under the impression(and hoping) that viral load rebound depends on the individual and some peak later rather than sooner.If someone were topping out at over 100,000 copies(but not knowing because labs have not been run yet) wouldn't they have some type of symptoms? I know I will find out soon enough, but does everyone return to baseline so fast?Thank you

Response from Dr. Wohl

No need to freak. I certainly understand and applaud your desire to keep your virus as low as possible but most people actually live with moderate to high viral loads for years prior to their HIV diagnosis or starting HIV treatment. And most of these individuals were asymptomatic despite their viral loads.

When people stop their meds the virus will pop back up. Generally this does happen more in the short rather than long run. Some can get symptoms with the rebound, akin to those experienced by people with genuine acute HIV infection, but this is variable.

When I stop medications, I warn patients that their viral load will go up but that we must keep our eye on the CD4 cell count and look out for symptoms.

Remember, its all about the CD4 cells. As long as they stay within relatively safe levels the viral load does not bother me that much. Let us know what your viral load did. DW


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