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High Viral Load..
Aug 9, 2007

Diagnosed poz 6/4 of this year. No symptoms - appeared as part of my annual physical/blood work. Follow up tests showed CD4 at 298/20%. Viral load was a whopping 262,000. Last HIV test was Nov '05....the hiv specialist and I have agreed to wait the 3 months/end of August for 2nd data points on tcells and v/l but at 49 I don't have the advantages of youth anymore and do want to start meds, most likely Atripla.

I can't find anything on viral loads...I read on these forums some folks infected/poz for years, no meds, and low viral loads. Is my high viral load somehow indicative of a recent infection? When I had my annual I did have a nasty cold it took me 2 weeks to shake, swollen lymph nodes, etc. Now energy is at about 90%, I am slightly depressed and anxious but my family has been terrificly supportive!

So, any idea why someone's viral load could be so high? Should I expect it decline a bit if I'm feeling better/perky and not yet having gone on meds? The dr told me all other results are great - no resistance, no hep b/c and I'm the type of hiv+ person that given advances in meds will highly likely die of old age so he told me not to plan to retire too early!!

Thanks in advance...not sure which forum - perhaps the board should consider one for the "newly diagnosed" as I'm sure we hog more than our share of the ?s!!

Response from Dr. Sherer

Viral loads are often in the millions in acute infection, and after 6 months they fall to a 'set point' that is a predictor of the risk of HIV disease progression. Your risk is moderate; viral loads above 100,000 are associated with a more rapid progression to HIV disease progression than VL<100,000. In addition, the CD4 cell count is a strong predictor of the risk of HIV disease progression (ie getting AIDS or dying from AIDS), and again, your risk is moderate with a CD4 cell count of 298. Neither of these key markers suggests that you are in the highest risk group, so that is good news.

Moreover, you have not had an AIDS defining illness (from what you have told me), and that is another good sign.

You have every reason to expect that ART will work for you. With the regimen you are considering, 2/3 of people on the drug were fully suppressed after 3 years in one study, and 3/4 of people were fully suppressed after 3 years in another study.

By current US HHS Guidelines, you qualify for ART promptly, and the choice of a single pill once daily sounds like a good one for you. You can ask your doctor if there are any other issues of concern with this regimen, e.g. are your kidneys in good shape? And have you been diagnosed with depression and on medications, or just feeling the blues for the good reason that you have just been diagnosed with HIV? These are considerations, but would not necessarily require a different initial ART regimen if present.

OK? the summary here is 1) 262,000 viral load is not that high, and no big deal for your best choices for initial ART; 2) the CD4 cell count also is a strong predictor of prognosis, so use both the CD4 cell count (and percent) AND the viral load; and 3) you should expect a good treatment outcome PROVIDED that you are able to TAKE EVERY DOSE AS PRESCRIBED. You control your own adherence, so make the most of the opportunity to take this simple regimen, and you could be doing well 5 and 10 years from now with the same regimen.

I suggest that you talk to your doctor about your concerns, and take this response with you.

Undetectable and suppression
Missed dose of Epivir

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