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HIV Drug ResistanceHIV Drug Resistance
           
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not quite undetectable
Jun 16, 2008

Diagnosed Jun '07. v/l at the time was 262,000 and tcells 350. no meds until Feb '08 but tcells stable and v/l kept dropping to 41,000 pre-meds.

now on Kaletra/Truvada (resistance testing said no NNRTIs) and a huge drop in viral load...but last test "blipped" from 176 to 225 and a log increase of 0.2 BUT tcells increased 100+!

I realize blips don't "count" until undetectable but now in a predicament since we can't do testing until v/l increases over 1,000. If coinfected with herpes (no other issues - Hep, etc) can it be possible to just linger in the low 100s and just never hit the <48?

COMPLETE adherence...greatest window was an hour for international travel which Dr supported.

Thoughts? Just think people sharing experiences helps....I am awaiting callback early next week as dr is on vacation and I don't use this in place of medical care nor should anyone else!!

keep up the great work - this site is awesome.

Response from Dr. Sherer

While most patients achieve an undetectable viral load after 4 months, some take longer, 6 months or more, and those that require more time are those with the highest baseline viral loads, e.g. >100,000. So it is not unusual that you did not achieve full suppression after 4 months.

Your last two viral load values, both the absolute number and the log value, were the same, i.e. you did NOT experience a meaningful or significant increase from one value to the next. A real change by log value is a > 0.3 log change, or a >3x change in the absolute value of the viral load. You did not have either of those, so the two last values were essentially the same.

Still, as you suggest, it is disappointing that there was not a further decline to an undetectable level. With the regimen you are taking, >80% of patients achieve a viral load below detection after 6 months, even among those with a high baseline viral load.

The very positive response in your CD4 cell count and the excellent decline of almost 2 logs suggests that your regimen is working for you, and that you will continue to decline to below detection soon. You and your doctor can also look back at the resistance test to be sure that there were no other resistance mutations that might impair the activity of either Truvada or Kaletra.

I suggest that you talk to your doctor about your concerns, and take a copy of these observations with you.


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