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VL increase
Sep 4, 2012

I started my treatment in April and since then my CD4 count went up very quickly up to 1050 from 444, but my Viral load has never got to undetectable. On my last test in August, my VL has gone up to 817 and CD4 down to 811. I had a very high VL when I started with the treatment, about 150000, and it has never been below 100. Is this normal? I have never missed a dose.

Response from Dr. Young

Hello and thanks for posting.

In general, we like to see the viral load get to undetectable levels after six months of therapy. That said, I would have expected your August VL test, 4-5 months after treatment initiation, to have been lower than the 800 level. The response isn't terrible mind you, it's a >99% drop.

A couple of questions that might help to explain things (assuming, as you've said, that you're adherent to your medications): First, was there a resistance test done on your virus before starting? (If not, the possibility of having a drug resistant strain could explain the lack of response). Second, did you have any type of illness, such as cold, flu, cold sore, sinus infection at the time of the test? Such types of things can cause transient elevation of the viral load.

Either way, I'd suggest getting a repeat test sooner, rather than the usual 3-6 month interval. This would help sort out if resistance was an issue, since one could expect that with drug resistance, the viral load would significantly increase at the next test. If not, or if the viral load remains very low, I'd be reassured.

Be well, BY

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