Rising Viral load
Oct 8, 2009
Doc: I have been undetectable for about the last 5 years until last fall. My viral load started to slowly creep up. Last November it was 200 in May of this year it was 1200. My cd4 count has also steadily risen and is currently 550. My doctor wants to swith me from Viramune and Truvada to Atripla. I don't want to switch if this is just a bleep. Is it possible to have a transient rise in viral load after being undectable for so long?
Response from Dr. McGowan
Thanks for your question.
Since you have at least 2 viral load values that are not undetectable and the second is over 1000 it is less likley to be a "blip". If indeed drug resisatnce is behind this increase (which it may very well be), then a switch to Atripla would not offer much benefit since the regimen shares a high degree of cross resistance with what you are currently taking. If your viral load is still above 500 it should be easy to get a drug resistance test (a genotype) to show if resistance mutations have built up in your virus and help guide a change in treatment. The CD4 count can continue to increase even after the virus starts to break through because your viral load is still partially suppressed and it is better than being off meds entirely. But you should strive to have undetectable virus, that is the best way to have long-term improvement and maintain your health.
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