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Do night sweats mean Viral Rebound?
May 7, 2003

I have been on HIV medication for 3 years and fortunately have been undetectable for each follow up but one. I am 100 adherant - never missed a dose. For the most part I feel healthy. However, on occasion, usually when I feel tired or run down, I will experience profuse night sweats - to the point I wake up drenched. This will go on for a few days (sometimes up to a week or two). Eventually it subsides after good rest and I feel rejuvinated. I consider myself to be very in-tune with my body and it has always been my impression that it is during these times that my virus is no longer undetectable and has "bounced back". Recently during one of these "bouts I had my blood taken with a vl OF 130. I know its not complete virologic failure but its worse than <50. I was wondering if this phenomena has been documented? My dr seems to shrug it off rather than verify. My partner has the same suspicion that their is some viral rebound during periods of night sweats. My 2nd question, concerning resistance, is there something I can do when I feel this viral rebound to prevent the on-set of resistance. Should I pop an extra combivir pill or be taking additional meds? I believe that more frequent VL tests could help monitor this problem and prevent resistance. Any thoughts...Please.

Response from Dr. Young

Night sweats (not just feeling warm, but the sheet drenching type) are almost always abnormal.

The key question is what is causing the night sweats--sometimes they are caused by rebound HIV viremia, other times from infections or even malignancies.

Yes, a viral load of even 130 represents a small increase and could easily explain the sweats. Because the viral load is so low, I probably wouldn't make more of it unless the night sweats return or if the viral load starts to increase.

As for prevention of resistance, the key issue is actually simple to state-- that is, adherence. Making sure that you're on the right drug regimen for your virus is key-- there is so much initial infection with drug resistance in the US (on average 8-10% of new cases) that you'd want to be sure that you're virus is susceptable even before you start on treatment. Frequent (every 2-4 month) viral load testing helps, as does not waiting a long time after a significant positive viral load to reassess or change tactics. -BY



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