Just continues to bounce

[HIV? poz about being neg]

Well I thought for sure after my October Lab work that Meds where coming this next visit. Well The CD4 is back up now at 420 at 25% but the viral load is also up alot 130 000 anyone have any thoughts?  I'm really not seeing a trend here at all.

[Movingon]

hey there - i am certainly no expert but one thing i do know is that a VL over 100,000 is considered to be on the high side, so if i were you i would start meds. Your cd4 is still pretty good but with a rising VL it might not be long before your CD4 suffers a bit

i was diagnosed with a v/l of 98,000, then it went to 256,000, then 306, 000 - so i started meds. Within 3 months i was undetetcable and my cd4 has doubled

i am sure some of the more experienced members here could give you a more scientific answer

good luck

[John2038]

ABOUT THE CD4 AND PLASMA HIV RNA TESTING
http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf (p. 7)

The absolute CD4 count is a calculated value based on the total white blood cell count (WBC) and the percentages of total and CD4+ T-lymphocytes. This absolute number may fluctuate among individuals or may be influenced by factors that may affect the total WBC and lymphocyte percentages, such as use of bone marrow–suppressive medications or the presence of acute infections. Splenectomy [4, 5] or coinfection with HTLV-1 [6] may cause misleadingly elevated absolute CD4 counts. Alpha-interferon, on the other hand, may reduce the absolute CD4 number without changing the CD4 percentage [7]. In all these cases, CD4 percentage remains stable and may be a more appropriate parameter to assess the patient’s immune function.


As far as I know, a 3% increase and above is considered as significant.


Plasma HIV RNA (viral load) should be measured in all patients at baseline and on a regular basis thereafter, especially in patients who are on treatment, as viral load is the most important indicator of response to antiretroviral therapy (AI). Analysis of 18 trials that included more than 5,000 participants with viral load monitoring showed a significant association between a decrease in plasma viremia and improved clinical outcome [8]. Thus, viral load testing serves as a surrogate marker for treatment response [9] and can be useful in predicting clinical progression [10, 11]. The minimal change in viral load considered to be statistically significant (2 standard deviations) is a threefold, or a 0.5 log10 copies/mL change.


My two cents are: your cd4 have significantly increase and still above the 20% (a more comfortable zone than around the 15% or below), but so do your VL.
Your CD4 absolute count is still acceptable.

But your counts aren't those of a healthy person, and you are in the gray zone between the healthy people count and the counts were HAART is recommended.

If it was me, I would have start to think starting HAART this year.
No, if it was me, I would have told my ID doc: I want to start now.

Now accordingly to the most recents guidelines, you are still fine out of meds, but accordingly to the latest study, you will be fine on meds.

Its to you and your doc to decide.

John

[HIV? poz about being neg]

Thank you so much for the responses. I am really trying to prepare my mind for the day I need to start med's. But a second question to this is this the reason there are people who are not on med's for over 10 years of being infected with HIV because they just stay in the gray area as you mentioned? Is it possible that I could stay in the gray area for along time yet.

[mecch]

Ask you doctor such technical questions. People i know who have many years HIV and no need for medicine maintain much lower viral loads than yours.

[madbrain]

Thank you so much for the responses. I am really trying to prepare my mind for the day I need to start med's. But a second question to this is this the reason there are people who are not on med's for over 10 years of being infected with HIV because they just stay in the gray area as you mentioned? Is it possible that I could stay in the gray area for along time yet.

We still don't know all the reasons why some individuals can be fine without treatment for long periods of time, and others not. That is still being studied by scientists in detail. But there are clearly some genetic factors involved. Certain genes have been identified like CCR5 that play a role. But the scientists are looking for more. I am part of one study of HIV controllers because my lab numbers have been exceptionally good so far, though I have only been positive for a little over 2 years.

With your viral load I would think it would be in your interest to start treatment now, but I'm not in your shoes.