VL going UP 4X

[peer_gynt]

Hi all,

I apologize if this has been asked elsewhere but I think every case is slightly different...

I have been on treatment (Atripla) since October the 7th, the same day my CD4 count was 124 cells/ml (13%), and one month earlier my VL was 147k copies/ml.
I am treatment naive, and havent missed a single dose, if anything I accidentally took an extra 12 hours later...
In November my VL went down to 254 (Happy PeerGynt!!) and my CD4 went up to 155, so everything seemed to be going fine.

But now, my latest numbers are confusing as my CD4 went up to 234 (good!!), but my VL also went up as it is in 995 copies/ml...

My doctor says I shouldnt worry about it, but I want to hear about other people having similar experiences, have you seen it? is it normal? Should I expect this kind of fluctuations? Any working hypothesis of why this is happening? 

I would appreciate any observation.

[newt]

Ideally you should (or hopefully your doctor did) do a retest of your viral load, it might be an error or one-off spike, and perhaps a resistance test if your new viral load comes back over 250.

Occasionally you see down/up/down/up/down patterns as viral load gets suppressed.

Technically speaking 250 and 900 could mean the same on a viral load test, there is a the limit to the accuracy of the test (range is from 1/3rd the result to 3 x the result on the piece of paper).

-matt

[eric48]

Hi,

I have been in same situation, a VL increase, although smaller than yours.

I can sympathize with the stress.

One thing you should bear in mind: VL is the measurable remains of previously infected CD4 as they die.

People with small amount of CD4 to start with, have smaller amount of CD4 that will be replaced.
Therefore the VL dynamics is, in that case, dramatically fast.

The immunologic (CD4) restore competes with that. Your 'new' CD4 are more 'healthy', will leave behind less and less VL
but in your case, they are all the sudden more many also. See what I mean.

Here, where I live, the guidelines are very strict in that respect and here is what my doc ordered in my case:
- a retest (as suggested by Matt)
- a newer resistance test on your latest blood draw as it can be performed since VL > 500. It is a bit costly and time consumming, but, better be on the safer side and
take the right decisions sooner

Failure on a first regimen is not rare and with the many options available, your doc will rescue you without doubt.

Yet, IMHO, the matter requires immediate and expert attention

Cheers and welcome to this forum!

Eric

[hope_for_a_cure]

Mine came back 4 times higher in the Jan 2012 results too.  I was freaked out and still dont like the fact that it did but will not get too worried just yet. 

I am thinking its the fact that I had a huge increase in my CD4 count during the fall of 2011 that gave me this result.  (logic explained by eric48).  The first half of 2011, my CD4s were in the mid 200s with my VL <30 then jumped to a CD4 of 473 with VL <20 in October.  Now the January 2012 draw shows CD4 389 with VL of 80. 

[peer_gynt]

Hi All,
Thank you very much for your responses.
I really appreciate them. Honestly I was freaking out so I didnt think on first understanding the protocol to measure VL. Went to different web pages from the sellers of q-PCR machines and saw the replicability has a sd. of 0.5 cycles.
So my numbers are almost the same.
Thank you again!!

-C