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Genotype
Jun 18, 2005

They are unable to get a genotype on me. Approx. 10 months ago my Dr. started me on Kaleetra & Combivir after much consulting & research. My CD4 peaked at about 150 & my viral load was undectable. Now my CD4 is at 63 & my viral load is at 150 copies. Any insight & input would be welcome. Thanks

Response from Dr. Sherer

Standard genotype assays cannot be performed when the viral load is below 1,000. There are some research assays that can detect a much lower level of viral load, but it is uncertain how to interpret the presence of mutations in very low quantity.

Since a significant change in viral load must be > 0.5 log, or a 3-fold change, and your last value was anywhere from 0-49 copies, the recent result of 150 copies may only be due to laboratory variation, rather than a real increase. And it is most likely a 'blip', rather than a real increase. You and your doctor will find the answer to this question when you repeat the viral load and CD4 cell count.

As to whether or not the CD4 cell count decline is significant, it would be useful to know if the CD4 percent changed in the same direction, and > 3%, to interpret this result.

You did not mention what level your CD4 cell was when you began ART. Some patients, usually those with very low CD4s when they start (eg < 50 cells), may have less than the optimal CD4 increase on ART in spite of good virologic control. The reasons for this are poorly understood.

So these results not be misinterpreted as bad news, given the above uncertainties. I suggest that you stay strictly adherent to this regimen and review the next values, and these thoughts, with your doctor at your next visit.


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