Sep 6, 2008
Are frequent blips in VL (under 2000) common? I've had about 4 now after 6 years of being undectable. Wondering why this occurs as I am very adherent to taking my meds. Thanks fo your help.
Response from Dr. Frascino
It's a bit difficult to give specific advice on "blips," because different folks define them differently. For instance, if your blips approach 2,000, that's fairly high. Most are in the hundreds. In general, a blip is a very transient rise in HIV plasma viral load from undetectable to low-detectable levels, which returns to undetectable levels quickly (within weeks). There are different theories as to the cause of blips, including:
1. release of virus from reservoirs or protected sanctuaries in the body where replication of drug-sensitive virus continues at a low level;
2. drug-resistant virus;
3. Immunological events, such as a concurrent infection or vaccination, which suddenly increase the number of infection-susceptible immune cells and result in a viral feeding frenzy. This subsequently causes a transient blip; and
4. variations in drug levels in a person hovering on the margins of total viral suppression.
Whatever the cause, most studies have suggested that there is no association between blips and loss of virologic control or disease progression. That said, if indeed you are blipping over 1,000 copies/ml, I'd suggest you get a resistance test (genotype/phenotype) at the time of your next blip, as you've now had four blips following a six-year period of being undetectable. The resistance test will let you know if you've developed any resistance to your current drug regimen.
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