Failing? What should I do?

Question

Hi Dr. Holodiny

I switched from Tiv/Truv to Tiv/Des in Aug 2016. Before switching, VL always (21 years) < 48. But 4 mos. later (Dec 2016): 105. Jan 2017: 74. Mar: 102. May: 103. Aug: 50. Dec: 303.

I never miss doses. The switch is the only variable I can think of that would account for the detectable VL. My Dr. ordered a Stanford resistance test. It showed no resistance. Dr. switched me to Genvoya 4 weeks ago. Test results today: 138.

I'm worried I'm more likely to fail in the long-term if my VL is consistently detectable [Vs <48] ... even if it's mostly less than 200?

What do you think I should do?

Thank you so much for your time.

Answer

I would be curious to know what your CD4 count/percents have been doing, and what specific resistance test was performed, as your HIV viral load is very low, and most labs would not perform a resistance test if the HIV viral load is < 500 copies/mL. In addition, what HIV genes were examined (i.e., HIV RT, protease, integrase)? In your case, all 3 should have been examined. Another test to consider is the GenoSure archive test, which tests for resistance inside blood cells when the HIV viral load result is too low. In general, most people don't have absorption problems when taking these HIV meds, but in certain circumstances blood levels of the HIV drugs could be tested to make sure you have enough in your system. Also need to make sure you are not taking any other medications or over the counter products that could be affecting the metabolism of your HIV meds. Sometimes adding an additional HIV med to mix for a short time can get the viral load to undetectable, but I don't think you are there yet for that.