How important is undetectable?
Dec 10, 2007
I have been + for 26 months, and have been on Atripla for 19 months. I have never reached "undetectable' My T cells have been over 800 for the last year, but my Viral Load seems to be all over the place. Three month checks have been 400, 1256, 52, 143 and now 410 in that order. I have a very good doctor that has asked if I want to add another Med to bring my VL under 50. Since my T cells are now in the high 800's, how important is bringing the VL under 50? I'm 47 and would prefer to keep all the bullets I can in my gun for future use as needed. Thoughts?
Response from Dr. Pierone
Although the treatment guidelines suggest that we should strive to bring the viral load to undetectable range, there are no controlled studies done to answer this question for your particular situation.
Given the stable and high CD4+ lymphocyte count it seems reasonable to sit tight. There are many patients who continue this regimen in the face of low level viremia and have many years of immunologic stability with flat or even increasing CD4+ lymphocyte counts.
The risk is that the virus may develop more resistance to this regimen over time. It is likely that the replicating virus has a K103N mutation and an M184V, but a resistance test should be performed to document this pattern. So chances are that the virus is already resistant to 2 of the 3 agents you are on.
Since we don't have high level data to guide us in your situation, my preference is to sit tight and stay with the same regimen for patients of mine with the same issue. It would not be wrong to add a 4th drug or revamp the regimen on the basis of a resistance test, but it may not be necessary.
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