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Blips (part 2)
Sep 10, 2008

Dr Bob, I think i may have worded my last question wrong. You answered it last week. I have had 4 blips during the 6 years I've been undectable. These did not occur concurrently and a few have only been in the hundreds. My doctor does not seem concerned but again, I was curious as to why I've had so many. Also does the VL have to be at a certain level for an accurate geno test? Thanks in advance.

Response from Dr. Frascino

Hello,

May have worded your last question wrong???? There is no "may" about it! (See below!)

I concur with your HIV specialist. Four "blips" over six years is not all that uncommon and not worrisome. You can read more about "blips" in the archives.

As for genotype and phenotype resistance assays, generally the HIV plasma viral load must be above 500 copies.

Be well.

Dr. Bob

blips 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

Hello,

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.

Good luck.

Dr. Bob



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