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viral load is not yet undetectable
Mar 11, 2012

Hello and thank you for this very informative website. It has truly been a blessing. My doctor has me on 1 Truvada, 1norvir, 2 presista and 1 bactrim a day. I take all at the same time every day and have not missed a dose since I began treatment. I have had HIV for 8yrs and waited until last year when thrush started to show up to begin taking meds. My viral loads were originally 35k my cd4 were at a very scary 4. After 5 weeks my viral load was at 100 and cd4 at 40. My doctor said it's normally caused by missing doses but I haven't. I took another test and the results come in next week. If the viral load is not undetectable after 6months of meds then we have a problem she said. what is the best course of action to take next and how do we chose the meds we take. It seems like we're just rolling the dice here. I assume there is a science to this. also I have not experienced any side effects from the drugs, and have been able to remain employed. If I have to go on other drugs will the next round be worse?

Response from Dr. Young

Hello and thanks for your words.

If I get this right, your viral load went from 35,000 to 100 in 5 weeks. That's over a 99% reduction.

You're doctor is over estimating the effect of meds- I generally don't anticipate HIV viral loads to reach undetectable levels until 3-6 months (not 1 month) after treatment starts. Yes, if you're not undetectable at 6 months, there might be a problem, but if you're adherent to your regimen (especially you had baseline resistance testing, and if you're taking a regimen that includes a boosted PI), the likelihood of this is very low.

Low level viral loads (like those in the low 100s) after reaching undetectability are a frequent cause of concern, but are often not the consequence of drug resistance, but can be the result of minor infections or inflammatory issues. A repeat test in a few weeks usually sorts this out.

If your viral load doesn't get undetectable, then the next step is getting HIV resistance testing. The results of resistance tests are used to help guide the next treatment regimen. With our current portfolio of medications, second- and even third-round regimens can be very well tolerated.

I hope that's helpful. Be well, BY



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