My lab results in today...

[Catman]

Well so much for my "undetectable" vacation. It lasted for about 9 months. Today I had my doctors appointment and he told me that my viral load had risen a bit to 345. Not to worry that it sometimes happens and may go back to undetectable at another moment. My cd4 results somehow had not been sent to the office so I'll have to wait until my next appointment in 3 months. I'm not to happy about this but I'm not depressed, either. Sort of neutral about the whole thing. I wonder if any of you on Fuzeon has had a vl rise while on the medication or if this is a sign of my body already showing signs of resistance? Newt may know the answer to this one but I'd appreciate any reply. All my other lab results were fine except for the always high triglyceride level, I'm use to that one already. Thanks. 

[Miss Philicia]

Yes, my vacation ended even sooner!  Six months.  But mine only blipped up to 100... so what?  It's not like it's some huge movement.  My doctor didn't seem concerned either, but said for me to have it checked again in a month to make sure it wasn't some new trend emerging. 

[RAB]

CAT

Was Fuzeon added to a regimen you had already been on or was this an entirely new regimen?

I agree with Philly, I don't know if I'd wait 3 months, I'd probably want to recheck in 30 days like his doc had him do.  Is that an option for you?

RAB

[koi1]

Yes,
I am wondering if waiting three months is a good idea. But I guess you also have to get your cd4 count back to get a better picture. My docs do labs for me every month but I guess it is because I am still under the 200 range, and not yet undetectable.

Philly is on the same med., so I guess he can say not to worry too much, and mean it.  A viral load in the hundreds is still very low.

rob

[Miss Philicia]

I should have qualified my "I'm not worrying" remark by stating that my cd4 count was pretty much unchanged and my % actually increased by something like a fairly significant 3 point change. 

[Catman]

Well my doc didn't seem concerned about it and he told me not to worry. I've been with him since 1994 so he does know my body well. He has seen me "rise from the grave" so to speak and he knows my immune system is one of the strongest he's ever seen. I guess all those immunization shots I got as a child growing up in a military family gave me good defences. He said he didn't think the cd4's had changed and the last time they were around 380 I think it was. I feel wonderful, though. Had a burst of energy today and had to hit the gym for the weights. I usually know when things are bad because something feels just quit not right whenever something is "out of order". I meditate and feel within and if I'd feel slightly sick or uneasy, I go to the doc. The doc's guesses always hit the spot so I'll wait until May. Since I am on a public government program for the moment, funds are limited and the vl and cd4 tests and meds have no charge for me so I have to wait my turn (so to speak). (RAB)The regimen I'm on came to be because I was resistant to almost everything else. That's when the Fuzeon, Aptivus, and Norvir came into play. I began with them last April of 2006 I think. I'll keep a close guard and if I feel "funny"(before the 3 months) I'll go to the docs private office and ask to do the labs again even if I have to pay a deductable amount. Still, it's not good being detectable again...and those new meds coming out this year better get here soon!

[tigger2376]

Here's to you not feeling 'funny'. I just thank my lucky stars I get my meds on NHS, Power to your pumping iron arm 
Lets just hope this a 'blip', and those scientists give us the goods soon
thinking of you, whatever
xxxxxx

[HIVworker]

It is trends and not isolated viral load readings that indicate resistance. At this point your next result could go either way....back down or up. That's still a very low viral load, and it shouldn't lead to panic buttons being pressed.

R

[RAB]

Hey CAT

Sounds to me like you're staying well connected with everything.  On top of that, you've got a doctor who knows you and with whom you have complete cofidence.

That's the best position any of us can be in as far as I'm concerned.

I can understand how being "detectable" is "not good", but the VL is still really low and considering where you started ("rise from the grave"), you're doing pretty damn well if you ask me.



Keep us posted buddy.

RAB

[Matty the Damned]

It is trends and not isolated viral load readings that indicate resistance. At this point your next result could go either way....back down or up. That's still a very low viral load, and it shouldn't lead to panic buttons being pressed.

R

Feline type person (you're not some sort of furry are you?),

Listen to the sage advice of the Science type person (HIVWorker). He is wise in these matters.

MtD

[budndallastx]

I was reading some case studies where people have blips showing a viral rebound but their CD4 count and percentages continue to increase.  The doctors indicated the color of the tube used for the blood draw plays a big role.  The test tubes used for draws have different colored stoppers at the top indicating the type of chemicals inside the tube.  The one needed for the viral count test must be lavender or light purple or else you may get erroneous results.  The techs substitute other tubes when they run out.

As Philly indicated, don't sweat it yet but next time you have blood drawn make sure one of the tubes used is purple.  If it isn't then the test isn't going to be suspect. 

Here's the excerpt from HIV/Journal Watch:

Recent data suggest that the problem could be in the processing of the blood sample. Although viral load assays are supposed to be drawn using EDTA tubes ("lavender-top" or "purple-top" tubes), most laboratories have been using plasma preparation tubes (PPT or "serum separator" tubes) for the convenience and safety of laboratory personnel. PPT tubes combine a spray-dried anticoagulant and a polyester material that separates the components of blood from the supernatant after centrifugation. Samples can be collected, processed, and transported in situ, thereby reducing exposure to blood-borne pathogens. After centrifugation, the tubes are typically frozen at -20oC and sent to the lab for analysis. Unfortunately, blood samples processed using PPT tubes are much more likely to show detectable viral loads than samples processed using EDTA tubes (12th Retrovirus Conference, Feb 2005, Abstract 738). The risk for false-positive viral load results appears to be associated with prolonged storage prior to centrifugation and freezing of the specimen in situ. It is now recommended that EDTA tubes be used to process blood specimens for viral load measurement or, if PPT tubes are used, that they be spun within 6 hours of phlebotomy. The plasma, but not the entire tube, can then be stored at 4oC for up to 72 hours after centrifugation. Most commercial laboratories now direct their personnel to process specimens in this manner, but the change is very recent.

[Catman]

I greatly appreciate the advice guys. I HAVE noticed that the caps on my blood samples are purple or light purple but in my last tests I didn't look at the tubes (I usually stare at the whole process of my blood being drawn). Maybe she did use a wrong tube because they do run  out of supplies every now and then. Still, I'm calm and will not get jumpy. It's just that in the 21 years that I've been positive this was the first time I turned "undetectable" and it felt really good and a weight was lifted off my shoulders for a while. And YES indeed, I have heard through other sources here that HIVworker is a brain in this matter and I appreciate his reply. Thank you, R. Also, I'm still lmao to if I'm a "furry type of person" that Matty mentioned in his reply. That really got a smile on my face.  I totally forgot about the hiv issue when I read that... laughter does make me feel hiv free!

[J.R.E.]

Hello Catman,

I have had a couple occasions, where the readings have gone up, and then back to undetectable. (see below)


Hang in there-----Ray

[HIVworker]

As was discussed when J.R.E. had a slight increase in viral loads and then went back down to being undetectable. This could be what is called a "BLIP". This is when the viral load goes up and down for no real reason. In an intense study the BLIPS were hard to reproduce, with only a single BLIP being recorded from two test stations.

Don't be too hard on the nurse, as although we are all human, it is too easy to say a viral load reading is "Wrong" because we don't understand it. Don't make the common mistake that the viral load is static, even on HAART. If you do ultra-sensitive sequencing you can see the viral load bouncing around at about 20 copies. The test is at the limit of quantification, but is probably real. Sometimes the level on HAART can be close to 50 copies and every now and again it can be >50 copies. A high viral load (1000s) is more troubling but low 100s is not. Indeed, this study sequenced viruses and found that BLIPS are not indications of oncoming resistance. Therefore depending on when the sample is taken (if one is taken when a BLIP occurred) you might see a viral load of >50 copies but below 500. As J.R.E's results testify the viral load can go down again and it isn't a sign of resistance and should not be a major cause of concern. Your ID doctor will be able to advise you and you should ALWAYS bring up your concerns with them and take their advice, despite what you might read on a forum. They see you, know your medical history. This forum and others offer things to consider discussing with your doctor.

I was interested to read the 'tube' story posted above. I've not heard of that. Interesting indeed.

R

[JPinLA]

Hi kitty-cat -

I have always been wary of results from a single test regarding levels of anything in my body, including this tricky, nasty virus.  I always wait for a corroboration from a second test and even a third to ensure a consistent and significant trend.  Having said that, when I do receive a result like the one you have recently received, I freak out (I am prone to overreaction, but I think it's human  ). 

I am a clinical immunologist developing drugs (alas, not HIV related) for a large biopharma in So. Cali.   I am too aware of BLIPS in any biological measurement and always look for consistent trends.  I agree with what people have posted so far..could be a BLIP, which could be due to variations in the actual test method used to measure you VL, artifacts in the test not from the method itself but in the collection method (i.e. PPT vs. EDTA tubes) or even the cycles of the moon (OK, that's facetious, but attempts are humour are all I have these days).

In any case, BLIPS and non-BLIPS should be verified by followup testing, try not to freak out by a first result (in my case this is never possible but giving advice is so much easier than practicing) and to reiterate HIVworker's sentiment, any and all concerns you have with your own health should be addressed with your ID physician.  Be aggressive with them, they work for you ( I just felt like a cheerleader).

Anyway, I understand if you're feeling freaked, wanting answers; you're entitled.  As a scientist, I try to stay as current with the research as possible but outside the field it is difficult to wade through the research and see the larger picture.  Reading one or two isolated papers pointing to one cause over another can be misleading (at least to me..).   So, I suggest, useyou medical team, ask questions, read on your own, breath, maybe drink a little, enjoy friends and family, post here...wait, I think I'm projecting too much.  I am tired and a little tipsy.

Please keep us updated on your results and good luck.
JP

[Catman]

More interesting advice. Thanks. I'm doing OK, so don't think that I'm going berserk or pulling my hair out because of the sudden rise in vl. I was just caught off guard when my doc informed me about it. He said it was still in control and even joked about me bossing him around (which is true) to the medical student (in training) that was in the office with us. He said it calmly and I didn't see any  facial expression revealing that he was hiding the truth from me. He just nodded and said everything was fine. I think the next testing will be more of a tell tell sign of whats going on. If it shows a lower count or even an "undetectable" count, then we will know better if it was a "blip" or not. Still I'll be picky on having my meds at the exact time of the day.

 Oh, and I almost forgot now that I mention "exact time". That blood sample was taken about a week after arriving from the leather convention (MAL) in DC last January. During my week there I had been having a few beers, staying up late dancing at clubs, and my "exact time" of having my meds was off schedule almost an hour every day during those days. I was usually walking towards the hotel when the timing was near but then I'd have to wait about 45 minutes for the Fuzeon to dissolve and then inject. Could this have helped the virus to rise a little? 

[tigger2376]

not had personal experience of fuzeion but am told that 'non compliance' after being pretty disciplined can knock things off.
Just to make you laugh, I got a call from my doc this week. 'Please come in your VL is up 15'...me 'oh my god, 150000!!!!!', them ,'no, just 15'
Had just changed meds at time of bloods, apart from being tired am fine..you just gotta laugh or you'll scream!
i hope my favourite 'super furry animal' doesn't think I'm belittling whats happening to him, Just take care of yourself
when are next ones?
x

[Matty the Damned]

Also, I'm still lmao to if I'm a "furry type of person" that Matty mentioned in his reply. That really got a smile on my face. I totally forgot about the hiv issue when I read that... laughter does make me feel hiv free!

Doll, if we don't laugh we cry. I'm glad I made you feel a little bit better.

MtD
(Who can be nice when the fancy takes him)

[Catman]

i hope my favourite 'super furry animal' doesn't think I'm belittling whats happening to him, Just take care of yourself
when are next ones?

 LMAO! I'm not THAT "super furry"! I'm beginning to feel like one of those "tribbles" that came out on the old 'Star Trek' episodes! To those who don't know, they were these little fuzz ball creatures with no legs, head, face, nothing. Just a small round ball of fur. Soft to the touch but would multiply horribly...!

 Oh, my next labs are on April 24 but the reading and doc appointment is on May 30th. I also will touch the topic of adding a third cocktail to my regimen because I'm really on two only because the Norvir is a booster for my Aptivus.


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[Matty the Damned]

Oh lordy! It's worse than I thought. If you were a furry (even a yiffie) I could understand. But a Trekkie?!?!?!

You sick fuck!

MtD

[Ann]

Hi Cat,

It's worth keeping in mind that the reason viral load testing isn't normally recommended for hiv diagnostic testing is because they have a fairly high rate of false positive results.

What this mean is that a person who is hiv negative has a PCR (the viral load test) done for diagnostic purposes and it comes back with a low number, such as the number your last VL came back with. It's entirely possible this is what happened in your case and it was nothing more than a "false positive". I think this is the real cause of viral "blips" more often than people may realise - especially when the number is very low.

We've seen hiv negative people over in the Am I forum come back with false positives - sometimes as high as in the thousands - quite a few times over the years, so it's not just rumour that it happens.

I'm looking forward to seeing you post your undetectable VL next draw.

Hugs,
Ann
xxx

[Catman]

Thanks Ann, and Matty "I'm a Trekkie at heart." I can watch re-runs a zillion times and not get bored. 

[HIVworker]

That's a good point Ann. I think that is sort of why BLIPS could only be found by two independent labs once in an intense study of BLIPPING. When you dig down in the dirt, often you can throw up the odd false positive.

I have screen-captured this thread as evidence of Matty being nice.

Rich

Kidding Matty, you have been kind to me in the past.

[Catman]

  Well, all of you were right! My previous lab results (3 months ago) were a "blip"! I just returned from my latest appointment and my doc said I was "undetectable" once again! He was right when he told me "not to worry" a few months back. That news was good, but I really got overjoyed when he told me that my cd4's had almost duplicated in amount since "God knows when"! The last time when the doc said my vl had risen to 345 he also said the results for the cd4's had not come in on time. Before that, I remember they were somewhere around 300. Now they jumped to 614 and that is the highest I've ever had in years! I once again feel like a burden has been lifted off my shoulders for the time being. I'll keep the faith going...

[Miss Philicia]

Congrats!  Knew it had to be a blip as you're on a really good regimen.  I had a similar blip a few months ago and that's all it was.

edit:  oh right, I see I said that up above in this thread!

I know you and I were in similar boats before we began these new treatments a year ago when we initially PM'd about it several times, so my question is do you FEEL physically better?  I know it's like night and day for me energy-wise.

[Matty the Damned]

Congratulations Feline Type Person!

Don't let the idea of being in the same boat as Philly take the gloss off this good news.

MtD

[Miss Philicia]

You really need to be pushed down the stairs backwards.

[Catman]

You really need to be pushed down the stairs backwards.

LMAO! Philly, I had a mental image of you doing this to matty!  You two are terrible!

 And by the way, I do feel physically great. For the past couple of months I've been strangely hyperactive at work. My arms are sort of begging me to go to the gym again, but I really don't have the time. I feel like a healthy hiv free person who wants to "download" some extra energy into someone else!

[Catman]

I forgot to mention, what is my % if my vl is "undetectable" and my cd4's are at 614? I never talk about % with my doctor.  I always forget to ask!

[Miss Philicia]

Should be clearly listed on your lab results.  I'm assuming you don't ask for copies of them.  My doctor really considers the % a more reliable indicator than cd4's I think, in terms of long trends.  There is no direct correlation between VL and % if that is what you are asking.

[allopathicholistic]

  Well, all of you were right! My previous lab results (3 months ago) were a "blip"! I just returned from my latest appointment and my doc said I was "undetectable" once again! He was right when he told me "not to worry" a few months back. That news was good, but I really got overjoyed when he told me that my cd4's had almost duplicated in amount since "God knows when"! The last time when the doc said my vl had risen to 345 he also said the results for the cd4's had not come in on time. Before that, I remember they were somewhere around 300. Now they jumped to 614 and that is the highest I've ever had in years! I once again feel like a burden has been lifted off my shoulders for the time being. I'll keep the faith going...

Very glad to hear this! {{Hug}} cuz I know you've gone through tons of s--t but now things are getting better!

[Christine]

Excellent news!!
Christine

[Longislander]

Great news Catman! nice CD4's, too!

Don't let a blip get you down ever again, ok??!!