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low level viremia
Mar 23, 2002

Recently my viral load had an "intermittent 'blip'" or "low level viremia". After being undetectable at <50 copies for close to 4 years, I had a viral load return at 103 copies. My CD4 count, which is normally in the 750-850 range was also up to 1101. A month later my viral load was again <50 and my CD4 count had returned to 764. I thought it was just a blip, but then, 2 months after returning to normal levels, my viral load was measured at 259 copies and a CD4 count of 994. What is up? And should I begin worrying about drug resistance? I am currently on Zerit, Epivir, and Sustiva, and have been on this combination since 9/98. I have 99.9999 adherence rate (only ever missed one dose). I love this combination due to the ease of dosing schedule and no experienced side effects. I am not looking forward to having to switch to protease at some point in the future, either, due to lipodystrophy and digestive side effects. Should I worry?

Response from Dr. Little

I share your concern and cannot absolutely guarentee you that you are not experiencing an early virologic failure. On the other hand, available study data to suggest that in fully suppressed people who have intermittent viral load "blips" - generally less than 200 copies - these blips do not predict virological failure. That is, people with low level blips, less than 200 copies do not generallly go on to fail their treatment regimen. The fact that your viral load returned promptly to less than 50 would argue that this was only a blip. With regard to your CD4 count - I would follow the percentage and not the absolute number to see if there have been any real changes. Any factor (such as a common cold) may cause your total white blood count to go up or down - this will in turn affect the total number of CD4 cells, though in general the percent of the total that are CD4 will not change greatly. Based upon the labs you have provided, I would not be especially worried, but would simply continue your excellent adherence, look at the CD4 percent, and await your next test results.


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