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Viral Load inching up
Jan 23, 2004

I have been on Viramune, Viread, and Epivir for a little over a year. Before that I was on Kaletra, Zerit, and Epivir, but changed regimens because of increasing cholesterol and triglycerides. On my current regimen, I had an undetectable viral load for about a year. Then my viral load came back at 100. My CD-4 count was 303, and before that was steadily in the 350-390 range. About 5-6 weeks after the VL100--CD4,303 tests, my viral load came back at 255 and my CD-4 was 596. Should I be worrying about resistance? What should I do in the meantime, since I understand that genotype testing (and/or phenotype?) is not possible until the VL registers more than 1000. By the way, since diagnosis/treatment in 4/01, my CD4 count has never been above 400. Thank you.

Response from Dr. Lee

As you know, the HIV viral load indicates how active the virus is and the CD4 (T4) cell count indicates the status of your immune system. Dr. John Coffin of Columbia University likened the viral load to the speed of a train moving on a track and compared the CD4 cell count to the amount of track remaining for the train.

Your viral load remains quite low (and therefore seems to be moving rather slowly). Your CD4 has now passed 500 (congrats!). So, we could say that you have even put the train in reverse and laid more track.

You are correct that it would be very difficult to test for resistance at this level of viral activity. But, there is possibly something you can do. Commonly an upward creeping viral load is indicative of a relaxation of adherance to the timing of medication doses. By tightening up on your scheduled dosing, you may be able to push the virus again to undetectable.

Otherwise, I believe that it sounds premature to switch to a different regimen. But, of course continue to keep a close eye on your numbers with your doctor.



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