Viral Load Blip ? Need Advise

[brooklynpoz]

Hello everyone.,
I received my new #'s today, and I was taken back. I hope that you can shed some light on the issue.
My issue is that I have been undectable for 2 1/2 years, and today I had a viral load of 362.
I am on Kaletra & Truvada, never missed a dose, nor was late.
My tcells have been 286 - 321 for 2 years, my % has been 18 - 21% for two years also.
My doctor said for me NOT to worry, it may have been a viral load blip, and he is sendinig me for a re-test in a month.

My fear is that it is some beginning of resistance. I was diagnosed 8/2004, started maeds 9/2004, tcells 160, vl 30,000. I went undetectable 2/2005, tcells slowly increased since then along with my %.

Please advise on this situation. Thank you in advance.

[RapidRod]

I'm suspecting that they used the less sensitive test to do your VL this time.  The one test states <400 is undetectable and the other is <50.

[gerry]

I suspect this likely represents a blip.  The re-test in a month is a prudent thing to do and if it goes back down to undetectable, then it was in fact a blip.  Try not to worry while you wait for the test.  There are also some nuances as to which test is used and how the blood sample is processed so that could be a factor as well.  In either case, the re-test would help make the determination as to what to do next.

[aztecan]

Hey Brooklyn,

This happened to me in January. I had a detectable viral load for the first time in more than 10 years.

Yes, it did freak me out a bit. But, I retested in a month and all was well. It was a blip, most likely caused by mishandling of the blood sample I supplied.

It could be, as Rod said, a different test was used, or perhaps the sample was sent to a different lab, or, as in my case, they didn't send the blood sample immediately. If they leave the sample sit for even a day without freezing/centrifuging, it can affect outcome.

There are many variables. Your doc is being both prudent and proactive by ordering another set of labs in a month.

Try not to let it get to you, I know how nervewracking it is, but remember that one test does not determine a trend.

HUGS,

Mark

[MOONLIGHT1114]

In 2002, after 6 years on the new PIs, I had my first "blip."  I freaked out and kept questioning my doc.  They said the same as yours did, that there was no need to worry.  I had another test done and my VL went from the previous 100s up to the 300s.  The doc still said no need to worry.  I was pissed!  I said I understood that the VL number was small and no cause for concern, but my point was, I didn't like the direction the VL was going in.  They just wanted to dismiss it, but I insisted.  They finally suggested doing a genotype, after which was found that I was resistant to the PIs.  I switched my meds. 

See Reply #5 in the thread below.......
http://forums.poz.com/index.php?topic=13739.msg170939#msg170939

Cindy

[aztecan]

Cindy was proactive in her response to recurring tests showing a trend of ARV failure.

That is why your doc is being prudent in ordering another set of labs in a month. If the numbers continue in the same direction, then a GART (resistance test) would be wise. Actually, nowadays, it is pretty much standard of care when ARV resistance is suspected.

Hey Cindy, you lasted six years on Fortovase? I was on its predecessor, Saquinavir. I also know why they reformulated it and re-released it as Fortovase. UGH! Nasty!

Anyway, Brooklyn, keep us posted on how things go.

HUGS,

Mark

[gerry]

Genotype resistance tests are useful when trying to determine if resistance is emerging in the face of detectable viral load while someone is taking antiretrovirals.  However, it is reliable only when the viral load starts going above 1000.  Kaletra + Truvada is a very potent combo, compared to unboosted Fortovase, which I gather was in Cindy's combo; so in this latter situation, detectable viral loads would need to be looked at more carefully as a sign of emerging resistance.  By repeating your VL in a month, which is a prudent thing to do rather than waiting 3 months to retest, your doc would be able to make a determination as to what to do next.  It becomes a dilemma when detectable viral load persists but is too low to run a resistance test.  But in your situation, we don't know yet if this is the case or if it is in fact just a blip. 

[AustinWesley]

In 2002, after 6 years on the new PIs, I had my first "blip."  I freaked out and kept questioning my doc.  They said the same as yours did, that there was no need to worry.  I had another test done and my VL went from the previous 100s up to the 300s.  The doc still said no need to worry.  I was pissed!  I said I understood that the VL number was small and no cause for concern, but my point was, I didn't like the direction the VL was going in.  They just wanted to dismiss it, but I insisted.  They finally suggested doing a genotype, after which was found that I was resistant to the PIs.  I switched my meds. 

See Reply #5 in the thread below.......
http://forums.poz.com/index.php?topic=13739.msg170939#msg170939

Cindy

Hey Brooklyn,

I was just about to ask if they had done a genotype on you before you started meds?

Cindy, thanks for posting that.   I would have been pissed too and I'm glad you stood your ground.  Thanks for the link also.

Wesley