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Viremia after starting therapy

Nov 22, 2010

I started Atripla 2 weeks ago (I had 200.000 VL and 220 CD4, 22%). I read that after 4 weeks I should have at least 99% reduction of viremia. Is it right? And how much should it be after 8 or 16 or 32 weeks? And what about the raise of Cd4 we should hope after starting therapy?

I don't understand a fact. Why if we are using a fully effective therapy, we need even 4-6 months for becoming undetectable? Don't it stop the HIV replication process? And why in this period we don't take resistance?

Thanks for your reply!

Response from Dr. McGowan

Thanks for your questions.

The intial drop in viral load should be AT LEAST 3-fold, so for you having a viral load below 66,000 is the minimum effect. Usually it is much faster, especially with our newer treatments such as Atripla. If it drops by 10 fold (1 log) or below 20,000 that would be fantastic by 2-4 weeks.

The intial drop is caused by killing virus in the activated CD4 cells...the ones out on the front lines engaging infections, etc. They are the most actively productive cells making virus. They contribute the most virus, and can get shut down fastest because they turn over quickly. After the first few weeks the rate of decline of virus slows down because that virus is produced from longer-lived cells. So, the reason it takes time for the viral load to drop even though the drugs shut down the virus competely is that the cells making virus are cycling at different rates.

The CD4 count usually comes up quickly at first and then has a more slow, steady increase that can continue for several years as new cells are made by the bone marrow.



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