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Still Detectable..... Aaarrgghhh

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bocker3:
I’m a bit frustrated that I can’t seem to get my VL down to undetectable and am at a loss at how best to proceed.  A quick review:
Tested positive 8/24/05
Sept 2005 – CD4=350 (25%), VL=98,559
Nov 2005 – CD4=288 (18%), VL=43,299
Dec 2005 -- Started on Sustiva/Truvada (first HIV meds ever)
Feb 2006 – CD4=521 (27.4%), VL=539
Apr 2006 – CD4=499 (31.2%), VL=643
June 2006 – Added boosted Reyataz to intensify my regimen
Aug 2006 – CD4=576 (30.3%), VL=111

I had resistance testing done in Nov 2005 and repeated in May 2006.  Both results were the same: 
NRTI mutations- 41L, 208Y, 211K, 215S   
NNRIT mutations – NONE 
PI mutations – 36I, 63P, 93L

So, it seems to me that with a PI, NNRTI and 2 NRTIs that I should be undetectable – of course I am happy that I did have what seems to be a significant drop in this last set of labs AND, I’m down about 99% from my highest VL.  Although, it isn’t as big a concern to me – I’m disappointed that my cd4 seems, basically, unchanged since February (but double my pre-medication level).  My adherence has been 100%.  I currently take all my meds at the same time (before bed), with a snack (usually a granola bar and 4 crackers with peanut butter or cheese).  No real side effects to speak of – although my latest Total Bili was 2.0 – but I expected that with the Reyataz.

My ID doc and I decided that we would repeat the labs in Sept -- to give the Reyataz a full 3 months.  I have no idea what I should do if I remain detectable.

Everyone keeps on telling me not to worry about the numbers, to focus on how I feel (I feel great) and my increased tcells (intererstingly, it is people who are negative or positives with undetectable VLs saying this).  I know what they say is true, but it's hard to move that down from my head to the rest of me.

At any rate -- thanks for letting me vent.  The good news is, while I may be disappointed by today's results, I'm not despondent.  I plan to be around for, at least, another 42 yrs..........

Mike

Eldon:
Hello Mike, it is Eldon. First of all, welcome to the forums where you will find love, encouragement, support, and many questions answered about HIV/AIDS.

You will find that you labs will fluctuate a bit. You have come a long way with your VL and it is now down to 111. It would be advised to continue to take your meds as prescribed by your doctor, change your eating habits, drink plenty of fluids, and get plenty of rest.

Wait until your next set of Labs and sit down and discuss them with your doctor. Again, it is stressed that you take your meds as prescribed on schedule and do not skip any doses.

Keep us posted, and again, welcome!

jkinatl2:

--- Quote ---Everyone keeps on telling me not to worry about the numbers, to focus on how I feel (I feel great) and my increased tcells (intererstingly, it is people who are negative or positives with undetectable VLs saying this).  I know what they say is true, but it's hard to move that down from my head to the rest of me.

--- End quote ---

I am def. one of the people who endorses that.. and trust me, you can smell my viral load down the street :)


Joe K:
Hey Mike,

You might try to just be a little more patient, because you have boosted your CD4s and decreased your VL, both by significant percentages and you have done this in less than a year.  It took me 7 years to increase my CD4s and to get to undetectable.  Forget the numbers for now and just enjoy life.

My belief is that a good VL is one you can live with and that does not require you to surrender your life to the numbers.  You are heading that way my friend.  It seems hard and I understand the fear, but the stress is just not worth it.  Give it some more time and relax.  All your numbers are moving in the right direction, so what's not to like?

HIVworker:
Just FYI there are three new NRTI and NNRTI mutations that have been found outside of the polymerase region of reverse transcriptase. They are thought not to cause much resistance but can augment existing common mutations such as Y181C etc. Currently this area of RT is not screened routinely in genotype assays.

Both NNRTI and NRTIs work well and are unlikely to be the cause of the low viral load you have, I just wanted you to be aware of these mutations as you appear very well versed in genotype studies.

R

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