Hi again Doc.

I wanted to thank you again for taking the time to answer our questions.

to answer your questions.

She is taking Truvada and kaletra. Again she is great about taking them everyday and on time. She never misses a day.

Her numbers have dropped again since the laryngitis went away. She is now around 20,000 on her VL and we did not check her CD4s. She is feeling better and we suspect her numbers will continue to drop. We are checking again the 16th.

You asked if fine on her drug resistance meant there was no drug resistance. Yes all the tests on her drug resitance came back as perfect and whe was accepting her medications well.

So again do you have any ideas on the cause and relationship of the laryngitis to her increased virul loads? I understand it is a hard question as we have had several local doctors try to figure it out. All of them just seemed to think she wasn't taking her meds which is not the case.

Also can you tell us what long term effects the increased virul load has on her? We are wondering if the high spikes when she has laryngitis is adversly efecting her short term and long term health. And if so how and whey?

Thank you again for you time in this matter.

Thank you for your follow-up posting. I trust her viral load will go back down to undetectable on this regimen if she is taking it consistently and had no drug resistance at the time her numbers went up. Certainly people who have an acute illness can experience increases in viral load. In fact, many suggest that viral loads not be performed at these times for just this reason. The explanation for why viral loads go up during an illness is not completely understood at this time and probably quite complex. For what it is worth, I do not believe there are any short or long term effects of her viral load having increased during this episode as long as it returns to undetectable levels. If the viral load does not go back down then consideration may need to be given to an alternative treatment plan.

Best, Eric