What's going ON!
Feb 26, 2010
I was undetectable for two years last time April 09. I took my six month test in October 09 VL 130 tested Nov 09 VL 360 Dec 09 VL 160 Last test 1-25-10 VL100. Doctor wants me to test again in March. I do not understand what is happening! I am on Atripla and Ziagen. Why is my VL fluctating? Do I need to change my meds? Please help I am confused. Pete in NY
Response from Dr. McGowan
It is unusual for a virus to "break through" suppressive therapy after 2 years. It could happen if you had slacked off and started missing some doses...that would be the first thought.
If not, then we would have to look at why you were on 4 drugs instead of the usual 3 (Atripla has 3 drugs in it) in the first place. If that was due to some pre-existing drug resistance in your virus than this new low level virus could be the continued evolution of resistance if the cocktail was partially effective due to those old mutations.
The last possibility is that there is some ongoing inflammation in your body...it could be from a virus like herpes or CMV that can be reactivated. Since this has been going on over a 3-4 month period your doctor should look for some cause of inflammation (immune activation). The list of possible causes may depend on your CD4 count...if it were low or dropping it opens up more possibilities.
All the levels are less than 400 which is good, but the level is too low to reliably get a new drug resistance test (although I would order a genotype just in case it blips higher). If no other cause is found and the VL remains detectable than the regimen may have to be "intensified" to see if that will stop the blipping.
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