Viral Load Testing

[Horizon]

Hi,

I went to the government fudned HIV clinic for my third set of blood tests yesterday (in London), and was told that the clinic now has a policy of NOT monitoring viral load tests for people who are not on treatment.
According to them, its only the CD4 count that triggers when treatment is needed.

I argued with the guy who took my blood (nurse), that I have just been recently infected and hence i need to understand my viral load so that I can me more comfortable with the disease progression. HE eventually agreed to do this, but i think I am gonna have problems in future.
It seems that costs are an issue and they are trying to cut down on costs.

They also do not routinely do the CD4% tests...just the absulute CD4 count.

I am wondering weather i should rather go to another Private doctor...
the current clinic is Free.

[Matty the Damned]

Well he's sorta right,

VL is a good indicator of how your treatment is going. If you're not on treatment it really doesn't tell us a lot. HAART supresses viral load. It stands to reason that if you're not taking meds, your VL is pretty much a number of little value.

CD4 count (and a careful observation of the CD4 %) is a better marker of immune function, which if you're not on treatment, is what this game is all about.

So get over yourself. Accept the expert advice given to you at your clinic. When you start treatment then your VL results will be remarkable.

This post is made subject to the views of the Newt.

MtD

[newt]

What MtD said...

For clinics which do not do viral load every time you go, an annual viral load test will (should) be in the clinic protocol.

At my clinic (Bloomsbury) which does this, the policy is not to refuse any test requested by a patient or doc. If you are unhappy speak with your doc.

But truthfully, the predictive value of viral load before treatment is practically nil.  Its the CD4 that counts.  CD4 count and/or clinical presentation (including how you feel) are the 2 factors used to decide when to start treatment. UK guidelines do not make reference to viral load now in respect of starting combination therapy.

CD4% is a calculated value (CD4 cells as a percentage of all lymphocytes) not an extra test. I do not know any clinic which does not do full blood counts as routine, cos they're cheap and informative. So you or your doc or your nurse can do the math. Probably the computer has done it already. This and CD4:CD8 ratio probably.

UK guidelines state you should have a resistance test as soon as possible after diagnosis and before starting treatment.  Hopefully the nurse did not say the clinic has a policy of not doing these.... A viral load immediately before starting treatment is good, because some drugs are not favoured for people with very high viral loads.

- matt