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Sick Related Or Drug Resistance
Feb 5, 2004

Diagnosed 2/2003 with VL 78,000 and CD4 208. Started treatment with Trizivir & Sustiva and have been 100 compliant. At each 3 month interval VL has been undetectable (<50) with CD4 range 320-373. Lab results today were CD4 399 & VL 137. I have been ill with sinus infection & had dental work prior to labwork related to abscessed tooth requiring root canal. Should I be concerned with VL 137 or is it related to my being ill as the doctor has said?

Thank You

Response from Dr. Sherer

I think your doctor is offerring you good advice.

Intercurrent infections and recent vaccinations are known to elevate viral loads transiently; that is a satisfactory explanation for this viral load value.

It is also worth knowing that the sensitivity of the viral load test at the lowest values, i.e. 50-150, is lower than at upper ranges, so this single value may not be significantly different than a reading of < 50 copies/ml.

And finally, minor 'blips' in viral loads, i.e. between 50 and 500-1,000 copies, are very common. In one study, they occurred in 40% of patients in one year. There is no evidence that minor blips like yours are associated with a worse prognosis, or a greater likelihood of virologic failure of the regimen.

Avoiding resistance
VL <50 :alternate tests and choosing HAART regimen

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