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Undetectable
Dec 31, 2004

I have an undetectable viral load and my CD4 count is very good and I am asymptomatic. If I continue to maintain this with medication and/or therapys; What does the virus do in this stage?

Response from Dr. Sherer

The most important thing for you to do is to maintain this excellent record by staying as adherent to your medications as you possibly can be.

There is good news and bad news in what the virus is doing while you are maintaining optimal suppression. The good news is that long term viral suppression for as long as six years in clinical trials and 10 years or more in clinical practice is well-documented and clearly achievable with the right combination of excellent medication adherence, the right regimen, and the right doctor-patient or clinician-patient relationship. Whatever the virus is doing in these cases, it is not disrupting excellent treatment outcomes and the return of the patient to a relatively normal life.

The bad news is that HIV replication continues in sequestered sites, such as the central nervous system and the gonads, even in the presence of excellent viral suppression in the plasma. With ongoing replication, new mutations also occur, though they do not appear to lead to regimen failure in patients with good virologic control in the plasma without other events that allow these viruses to become the dominant species, events such as lapses in adherence, or interruptions in the regular supply of drugs.

One thing for sure, the virus is not spending any time thinking about what you are doing while it is maximally suppressed. While I do encourage you to learn as much as possible about HIV, in my experience most patients get into trouble with their own issues and behaviors that compromise adherence. While you're learning about HIV, don't forget to take care of business.


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