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35k to 500k in 3 months
Aug 7, 2004

Hello Doctor, I tested positive in December 2003. Initial results-(vl,cd4) (97,000:349) and after monthly testing for 4 months ended at (35,000:450). It has been three months since the last test I took and these are the results-(500,000:350). My doctor is recommending I consider HAART very soon, but I want to know how this dramatic change in viral load happened (if possible) and see if I can use a non-med approach. I want to exhaust all available options before I start medication.

I am getting another blood test to confirm the first, and will probably be testing monthly again (at my request, at least until viral load drops, hopefully).

During the three months before the test, I had many minor/major accidents. I fell of my bycicle and severely injured my left wrist, without breaking anything. Also my shins and left elbow suffered significantly. I also suffered head trauma two months ago on the forehead, which swoll about the size of a golf ball where I was hit accidentally. Could these and other minor injuries have activated my immune system which exponentially replicated the virus?

I felt like the most accident prone person I knew. What would you suggest be an indicator that I truly begin therapy if the next test results are similar? Wait until cd4 is between 250 & 300? I am not going to take meds until I do my own research on them, but I know the time will come (sooner or later as I now realize). Thank you for your valuable input.

Response from Dr. Young

Thank you for your post.

It does seem like your viral load has increased-- more than would be expected from just day-to-day variations. The first thing to do is to have the viral load test repeated; there are so many cases where the VL goes up and then returns to "normal" for no particular reason.

Unless you're ill currently (with something like pneumonia or shingles), I would have concern that the increase to well over 100,000 could be a premonition of disease progression (as it typically is in the population of persons with HIV). I don't think that simple trauma explains the increase.

As to whether to start treatment or not, merely having an elevated viral load (even if confirmed) isn't sufficient in my mind, to mandate initiating treatment. It would be a good idea to discuss the pros and cons of starting with your doctor-- I typically don't force the point until the CD4s are around or below 300, but understand that this is a point of considerable scientific and medical debate.

Good luck, BY


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