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Viral Load Increase
Jul 10, 2008

I am HIV+ and have been for 20yrs. My CD4 count has alway been over 600 and my viral load has been undetable. Recently i went for my regular6 month checkup and was told that my viral load is over 1500. I am taking my anti viral medicaton but i do tend to skip 1 or 2 days of week of taking my meds. I am also a recovering substance abuser but have fallen off my wagon recently and resorted back to using drugs. Is this the reason why my viral load has all of sudden become detectable? What can i do to make my viral load undectable again? Will my viral load go down again? I am scared.

Response from Dr. Frascino

Hello,

The most likely reason your viral load is spiking is that you've developed resistance to one or more of your current HIV drugs. Resistance can and often does develop when HIV medications are not taken as directed. When you "skip 1 or 2 days a week," you allow the HIV in your body to begin replicating again. (It can reproduce itself billions of times within a single day!) As viral replication takes off, genetic mutations occur and the virus can become resistant to one or more of your HIV medications, making them essentially useless. Your substance abuse could also be contributing to revving up your viral replication as well as your poor adherence in taking your mediations as prescribed. You report you are scared. You have legitimate reason to be very concerned. I hope you take this as a wakeup call that you need to clean up your act.

I would advise you make an appointment with your HIV specialist ASAP. Be honest with him. Advise him about your drug use and also your poor compliance with your HIV medication regimen. He'll need to run resistance tests (genotype and phenotype) to assess what genetic mutations have occurred and what HIV medications are no longer helpful in controlling your virus. Hopefully, he will be able to put together another effective combination regimen that you will be able to tolerate.

You may well have been HIV+ for 20 years, but if you expect to have any chance of being here 20 years hence, you better clean up your act now!

Good luck.

Dr. Bob



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