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Viral Load Spikes
Aug 21, 2007

I've been positive since August 2005. With an initial t-cell count of 350 and viral load of 160,000, I was immediately put on a HAART regimen of Combivir and Sustiva. Due to the horrid nightmares I had on Sustiva, my therapy was changed to 150/300mg Combivir, 2x/day, 200mg Viramune, 2x/day and 300mg Viread, 1x/day.

In the past year, I've had a few spikes in my viral load. In Nov. '06, my viral load was over l00 (previously undetectable.) In March 2007, I was undetectable once again. In June 2007, my viral load had spiked to 490. July 2nd, down to 168 and now, on July 23rd, up to 298. My T-Cell count has remained in the range of 600-800 throughout these spikes.

I recently went for a second opinion, since my gp recommended a resistance test due to the many "blips." The second doctor dismissed a resistance test and suggested monitoring for awhile, since a resistance test would require me to temporarily stop my HAART to bring the viral load above 1000 to properly administer the test.

What are your thoughts of these spikes in my viral load? What does this exactly mean? Both my doctors tell me it's nothing to worry about, but is this something I should be worried about? It seems as though the virus is progressing. Is a resistance test appropriate at this point?

Thank you.

Response from Dr. Wohl

There is no harm in trying to get a resistance test even without stopping your meds. Occassionally, a genotype can be done when the viral load is lower than 1000. Any detected resistance would be meaningful. The absence of resistance would need to be taken with a grain of salt given the low viral load and the risk that sampling of the few viruses present was not representative.

While it would be preferable to have a viral load that behaved by staying less than the magical 50 copies/mL, having such low level virus on occassion should not pose a huge threat to your health. I would get the resistance test as described even though the yield is low. You can also consider a change in your regimen as it is a fairly unconventional combo.

Something like Truvada plus a Norvir boosted PI would be a more assuring regimen in my book. Any persistent spikes or low level virus on that regimen I would chalk up to trafficking of virus from place to place and not necessarily evidence of treatment failure.

DW



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