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WHY NOT UNDETECTABLE
Aug 12, 2006

Doctor, My VL in Feb was >100,000. Started on Sustiva and Truvada 21 weeks ago. Since then VL reduced to 1600, 300, and then 200 at week 21, when I had flu. Do you think that this is a good reduction as everything I have read indicates I should be undetectable by week 20. Do you think I should consider a change of medication and if so to what? Would my flu have effected the VL levels. Next results due at week 26. BTW been 100% adherant and resistence testing done prior to being perscribed medication. I am in the UK but suspect we have the same medications as the US available. Thank You.

Response from Dr. Sherer

I see no reason to panic or switch medications at this point. People with higher baseline viral loads take longer to fully suppress, even longer than 6 months. Your viral load - "> 100,000" - might have been 200,000, or it might have been 2,000,000. This is one reason that I prefer the routine PCRNA, rather than the ultrasensitive, for a first viral load result; it is helpful to quantify the height of the viral load prior to therapy. Afer that, the ultrasensitive assay, which offers a lower threshold of 50 copies/ml, is more useful to monitor the impact of therapy.

You are right that a viral infection - 'the flu' - might also have added to a failure to suppress, or perhaps you did fully suppress, but were not tested at that moment, and then had a blip with the viral infection.

I would also regard the course of your CD4 cell count and percentage, as well as your clinical status, as useful information to make this decision, and note that I lack this and other key information.

So be patient and await your next tests. There is ample time to change, in the event of a virologic failure, but the more likely outcome here a prolonged time to full suppression.

I urge you to talk to your doctor about your concerns and this answer, as he or she has all the information needed to inform these decisions.


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