POZ Community Forums
Main Forums => Living With HIV => Topic started by: living coach on July 30, 2013, 06:16:47 pm
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Hello All, this is my first time posting here, although I tested positive over two years ago now. For the last year and a half I have been undetectable, but today's number showed my viral load at 99. My CD4 were up from 400 to 780 and my precentage was up to 34%. My specialist was not worried and said that we will do followup workup in 3 months that it is most likely a blip. I don't ever remember missing a dose, but worried about regimen failure. Just looking for some positive words. Thanks
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I don't ever remember missing a dose, but worried about regimen failure.
a couple comments about your situation:
a) adherence rates of >=95% have been proven to retain successful therapy. this means that you can miss several doses easily and not lose UD. Missing one dose (which you didn't even do) has never resulted in treatment failure. By the way, that huge jump in CD4s clearly refutes treatment failure. :D
b) since the vl level of UD used to be 500, 99 isn't all that. LOL Then it was 400, then 200, then 100, and now down to 2 in some places. The scientific definition of UD is simply based on what low level the currents are able to measure to.
IMHO, i wouldn't even call 99 a blip. Now when I had a viral load that jumped up to 1280, now that was a blip. ROFL Also keep in mind that samples get tainted and labs are not perfect in processing and returning results.
stick to your meds, and I'm betting your next labs are back in line ;)
by the way, if your doctor is waiting another three months to retest you, then it's pretty clear that he's not concerned about your numbers at all - so why should you be? LOL ;)
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LC,...
Try not to worry about it. I had several of these very small rises in the first two years of starting treatment, and each time, it went back to undetectable on the following labs. I even had one read around 1150 one time. The doctor considered that a lab error, because on the following labs, it went right back to <40.
See my signature line... at the bottom.
Take care---Ray
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First, welcome to the forums.
Trending is more important than any individual test. If you see a pattern of increased VL over several tests, then there MIGHT be an issue. Otherwise, any single test should not be considered definitive.
Back when my cd4's were dangerously low, I watched slow improvements and plateaued around 500. I suddenly rec'd tests results that indicated a cd4 of around 1800. My graph suddenly looked skewed. Subsequent testing revealed a "normal" range for me. The take on this; we dismissed that one test as an anomaly or inaccurate test.
best wishes
Wolfie
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Also keep in mind that samples get tainted and labs are not perfect in processing and returning results.
I have to comment on this, because as a former lab professional it disturbs me. (don't take this personally Mikie -- I've just seen too many "it's lab error" comments on these forums and need to get this off my chest. I get your intent here)
a. Samples certainly almost never get "tainted", which implies samples being mixed together or things (live HIV viruses) being added to it.
b. For HIV viral load testing, a "lab error" is most likely due to improper handling of the specimen upon drawing. There are some very specific steps that need to happen to ensure erroneous results don't happen.
c. Of course, it is possible that lab instrumentation can produce erroneous results or someone can mix up results between patients. However there are safeguards that should be built in at all labs which minimizes this.
d. Most results that appear to be different than expected are likely due to actual biologic variation within the human body vs. any real lab error.
To the OP -- I do agree with everyone else, a lone 99 VL result is nothing to be overly concerned. Whether the 99 is due to improper handling or an actual biologic "blip" is immaterial - you will likely find yourself back to UD upon the next test.
Mike
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Hello All, this is my first time posting here, although I tested positive over two years ago now. For the last year and a half I have been undetectable, but today's number showed my viral load at 99. My CD4 were up from 400 to 780 and my precentage was up to 34%. My specialist was not worried and said that we will do followup workup in 3 months that it is most likely a blip. I don't ever remember missing a dose, but worried about regimen failure. Just looking for some positive words. Thanks
Most people get concerned when they have a "blip" in their viral load, but it has happened to just about everyone I know. Take a deep breath, and relax. Since your CD4s are almost double, something seems to be working well!
Just keep taking your meds regularly, and let us know how the re-test goes.
Cheers,
Henry
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I need to first say that I wholeheartedly agree with bocker. using "lab error" is a cop out excuse and does wrong to a group of hard working people. Also my usage of the word "taint" should have been written better to reflect the same notion bocker stated as "improper handling of the specimen upon drawing" - situations like the sample being too hot, too cold, held too long, etc.
this is from a PM, I sure bocker won't mind me using it here ;)
A blip is a blip -- the increasing sensitivity of the tests is simply increasing when a, most likely, meaningless single instance of a "detectable" VL is seen. This is, IMO, mostly real increases and not likely, all the errors going on.
i totally agree! I think we were probably all having "blips" in the hundreds when UD was 500, 400, 200, even a count of 100 as UD would have hidden the OP's slight rise. It's just now when UD can be measured so low that we notice these jumps. None of these rises, blips, whatever, has ever meant treatment failure or even a problem at all.
and few more things just occurred to me. Undetectable doesn't mean cured. What undetectable means is at that moment in time, very little of the virus could be found in your blood. Studies some that UD in semen is totally different and very often when your blood is UD, a count from your semen may not be.
this leaves a question then, if your blood is UD but your semen is not, just what does that mean as far as the state of someone's health? (since studies have shown the VL is semen is often very tiny, nothing is the correct answer LOL)
Also remembering that undetectable does not mean cured, this means we all still carry reservoirs of virus. (this is why stopping meds although HIV to flourish once again) Periodically these reservoirs spill out. Of course the drugs in your system work like PrEP and PEP and deal with this new virus floating in your system.
And here's the rub (wow. that's the second time I've used that phrase in a post this evening), IF you were being tested right after that reservoir spill-over and before your meds took care of this new virus, you would find a "blip" in your results. What we probably would find if we tested a person much more frequently (every week, every day, every few hours. I'm not a biologist and don't know this answer), I'm sure we would find that none of us actually has a constant UD viral load.
maybe I'll never suggest lab error again ;) ; but stick with the basic fact - none of us are cured and HIV is an incredibly resilient nasty bug.
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Periodically these reservoirs spill out.
Last summer, my partner took part in this study: http://england.ukcrn.org.uk/StudyDetail.aspx?StudyID=10473
I was initially concerned because the several pages of study explanation he brought home didn't mention the intermittent part of "plasma HIV viraemia above the local lower limit of quantification" that is included in the study's Main Inclusion Criteria section.
("Adults with evidence of unexplained intermittent or persistent plasma HIV viraemia above the local lower limit of quantification.")
Due to my concern, I had a long talk with our doctor (the "chief investigator", Prof SH Khoo) about it. You have to understand that my partner is one of those people who never pays attention to his lab results - he just wants in and out of the appointment as quickly as possible, so he had no idea what his VL results had been. Drives me nuts.
In a nutshell, they're trying to find out if the brain and spinal fluid are amongst the reservoirs that may occasionally "spill over", creating VL blips. Our doctor was very explicit in explaining to me that when these blips occur, it's normally just a "snapshot" of a "spillage" before the meds have enough time to move in and mop up the spilled virus.
There's a bit more to the study than that, but the point above was why my partner (who has intermittent blips) was ask to take part.
Turns out that the word "intermittent" being left out of the study pack given to test subjects was more of a typo than anything. But jeeze-louise, it gave me a shock, thinking he had a persistent low-level VL despite being on meds for years. I'm just glad my partner gave permission for our doctor to discuss his medical details with me. Our appointments don't coincide very often, so it wasn't like he could be there with me for the discussion.