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Viral Load and Resistance
Nov 22, 2002

Susan: I am having some issues with getting my viral load below the gold standard of "less than 50 copies". Over the course of the last year, I've had VL levels of: 555, 746, "less than 400", 1,012, 60, 83, 155, 74, "less than 50", and 130. We are watching this very closely, because while my Dr. (a highly experienced HIV specialist) is pleased overall, he wants me get below the 50 copies threshold. In the past, I've had both genotype and phenotype testing which suggested I was sensitive to all meds. My Dr. says that these VL levels very likely have nothing to do with resistance, and that some people just take longer to get below 50. Do you agree with this? And is there a correlation between someone like myself and my VL levels and the likelihood that resistance will occur? By the way, since beginning meds 14 months ago, I have been 100 compliant.

Response from Dr. Little

Well, I share your physicians desire to see your viral load less than 50, and while numbers like 60, 83 and 155 are more acceptable, I am less than thrilled with 746 and 1,012. After 14 months without complete suppression, I would have favored either another perhaps more potent regimen - or intensification of your current regimen (assuming that you still have no drug resistance). I will agree however, that I also see people with these kinds of numbers and very occasionally, they do go to less than 50 and stay there - though my experience is that not many of them after this kink of a stuttering course. So - I would discuss these two options with your care provider - I do not know that I am right, but the longer you are not fully suppressed and have viral loads greater than 500, the more concerned I would become.


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