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HIV Drug ResistanceHIV Drug Resistance
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Oct 10, 2007

My Dr. from the beginning always said when the viral load goes up my t-cells go down. Why is my viral load going up and so are my t-cells? I was undectectable for 1 1/2 years with t-cells around 200, now I have a viral load around 1000 and my t-cell count is at 343. What's happening?

Thanks to everyone for that great advise.

Response from Dr. Sherer

First, I would not weigh a single set of lab tests too heavily; the first response to such results is to repeat them, to ensure that a laboratory error is not the source of your, and possibly your doctor's confusion.

It is not uncommon for the kind of discordance you report, i.e. for a rising CD4 cell count in the face of an apparent rise in the viral load. Most commonly, the explanation is a single short-term 'blip' in the viral load, i.e. a single temporary elevation of the viral load which upon repeating the test disappears. A level of 1,000 copies/ml is on the high side for a blip, but that still may be the explanation here. The rise in your CD4 cell count suggests that you have had good virologic suppression up to this point, and you were previously undetectable with your viral load, so that is still the most likely explanation.

Another possibility is that you are just now developing virologic failure, and perhaps resistance to one or more drugs in your regimen, and that has yet to affect the level of your CD4 cell count. When you repeat the viral load and CD4 cell count, your doctor can also ask for a genotype resistance test in order to determine whether drug resistance to one or more members of your ART regimen has occured.

You can also ask your doctor to look at the CD4 cell percent, which is a way of understanding the magnitude in the increase in your CD4 cell count. If the CD4 percent did not increase more than 3% compared to the percent when your CD4 cell count was around 200, the apparent increase in your CD4 cell count may be less meaningful.

You should report to your doctor whether during all of this time you have been reliable with your adherence to your current ART regimen. The most common reason for virologic failure and drug resistance is poor adherence. You may want to discuss ways to improve your adherence, if that has been a problem. (Understand also that these types of events can occur, even when you have been nearly perfect with your adherence.)

As above, I sugget that you talk to your doctor about your question and these responses.

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