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Author Topic: low viral load at 6mos  (Read 3751 times)

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Offline indigolime

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  • Posts: 8
low viral load at 6mos
« on: June 27, 2009, 04:37:20 AM »
After 23 yrs of testing negative I tested poz on 6/4/09.  I was mortified and didn't really feel human again until I found this site around 6/19 and started following these posts.   Reading about your experiences has brought me back to life over the last few days.   Thanks so much for sharing your knowledge and for your encouragement.
 
I saw my "ID" for the first time yesterday.  He was enthusiastic because my viral load was "very low" at 379.   He told me there are some people who never need meds, that they have a natural resistance to the virus, and that I may fall into this category.  He didn't elaborate, and I didn't ask questions but now I wish I did since I won't see him for 3 months.

Does anyone know about this?  He estimates I was infected around 1/09.  What percentage of infected patients maintain low viral loads and normal cd4 without meds?  Can the virus do damage at these levels?   



 
12/08: negative
likely infected 12/08-3/09
6/4/09:   positive
6/09:   cd4 617;  36.4%;  vl 379
9/09:   cd4 579;  33.1%;  vl 3730
12/09: cd4 558;  31.0%:  vl 1880
4/10:   cd4 500;  30.0%;  vl 3890
     Isentress/Truvada started 4/19/10
6/4/10:  cd4 518; 32.0% vl undetectable

Offline Assurbanipal

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Re: low viral load at 6mos
« Reply #1 on: June 27, 2009, 08:47:44 AM »
Hi.

Welcome to the forums.  Great that your viral load is so small 6 months out.

There are a small percentage of people who can naturally control the virus.  If you use the search box (to your left and down on the screen) to look for "Long Terrm Non Progressor" or "Controller" you'll find a lot of info.

Assurbanipal
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline Luke

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Re: low viral load at 6mos
« Reply #2 on: June 27, 2009, 09:12:02 AM »
Without medication, perhaps 25% can retain a relatively healthy immune system for as long as ten years after infection; but even amongst the rarer two or so percent or who stay healthy for 15 or 20 years, the number of people who can stay healthy without meds decreases dramatically the longer you observe them for.

For now, until you have a better idea how your infection is progressing, I wouldn't personally advise you pinning any of your hopes on being one of the few. Mentally prepare for the fact that you are likely to be one of the 70% who need to start treatment within five years of infection, and use that time to grow used to the fact that starting treatment isn't the end of the world.

After the initial acute phase of infection has passed, it is perfectly normal for your viral load to come back down to a really low level; so it is far too early for you doctor to be talking about you possibly being one of the people who don't ever need meds,

Offline indigolime

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Re: low viral load at 6mos
« Reply #3 on: June 28, 2009, 06:22:34 PM »
I have no problem with meds.  The virus replicating in my body scares me more than the meds.  The genotype test came back with no resistant mutations, and the labwork showed no coinfections so the door is wide open in terms of the combinations of drugs which will work for me.  I tend to lose weight easily and mentioned Atripla and he tells me Miravorac with Truvada would be better.   Yes,  I agree it was odd and premature that my doctor (who is an HIV specialist going back to the 80's) would suggest I'm a controller after one lab.   617 cd4 is not that far away from 500, which I've decided will be my starting point for HAART.

Scanning members' profiles there are wide variations of numbers after the first one or two lab results.  One member started out with normal cd4 and a very low viral count the first 2 labs, but was on Atripla within a year after the 3rd lab revealed the viral load shot up with a corresponding drop in absolute cd4 count.


 
12/08: negative
likely infected 12/08-3/09
6/4/09:   positive
6/09:   cd4 617;  36.4%;  vl 379
9/09:   cd4 579;  33.1%;  vl 3730
12/09: cd4 558;  31.0%:  vl 1880
4/10:   cd4 500;  30.0%;  vl 3890
     Isentress/Truvada started 4/19/10
6/4/10:  cd4 518; 32.0% vl undetectable

Offline Inchlingblue

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Re: low viral load at 6mos
« Reply #4 on: June 30, 2009, 02:24:55 AM »
Maraviroc is a very odd choice for first-line treatment, especially given you have no resistance issues. I think it is currently being tested for first-line and it's possible that it will be used that way in the future but very odd that he would choose that specifically over so many other options.

Additionally, even though the chances of having X4-tropic virus are slim for someone newly infected, I'm pretty sure you'd still need to do a viral tropism test in order to take Maraviroc, to make sure that your virus is R5-tropic.

Did he give you a reason why he is suggesting you start with Maraviroc?

Offline indigolime

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  • Posts: 8
Re: low viral load at 6mos
« Reply #5 on: June 30, 2009, 09:23:36 PM »
My concern (ok fear) is facial lipoatrophy, and I wanted to get a head start researching drug combinations which were least likely to cause it.    When I mentioned my concern and asked about Atripla, he repliedTruvada with Insentress or Truvada with Miraviroc would be safer, emphasis on the latter.   I am lame , I should have asked more questions, but even so I've been reading these posts for 2 weeks I never recall seeing Miraviroc mentioned, however I have read positive reviews of the former combination.   I am not wild about taking anything having not time tested. 

Why wouldn't viral tropism be on my genotype test if the intent of the testing is to rule out drugs which will be ineffective due to resistance?
12/08: negative
likely infected 12/08-3/09
6/4/09:   positive
6/09:   cd4 617;  36.4%;  vl 379
9/09:   cd4 579;  33.1%;  vl 3730
12/09: cd4 558;  31.0%:  vl 1880
4/10:   cd4 500;  30.0%;  vl 3890
     Isentress/Truvada started 4/19/10
6/4/10:  cd4 518; 32.0% vl undetectable

Offline Inchlingblue

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Re: low viral load at 6mos
« Reply #6 on: July 01, 2009, 03:09:09 AM »
I also have major concerns about lipoatrophy. I will be starting soon and have decided on Isentress/Truvada. I'm hoping, based on a lot of research that this will be less toxic than others and will work out as far as lipo, but at the end of the day, there are no guarantees.

There are small studies (and others in the pipeline) looking at Isentress/Reyataz, which would be awesome if it was found to suppress virus because they are both very good drugs, low toxicity, NRTI-sparing combo and it's only two drugs, so also it would be less stress overall on the body and cheaper. For now it's too soon to be trying it out until more tests are done.

Viral tropism tests are fairly expensive (maybe the price is coming down, but still relatively expensive) so they are not usually ordered unless necessary. It is not part of usual "resistance" testing. It's possible your doctor ordered it already, especially if he is suggesting Maraviroc.

My only concern with Maraviroc is that there have not been many studies with treatment naive patients so things such as interactions with other drugs etc have not been completely ironed out. At least with Isentress, it went head to head up to 96 weeks with Efavirenz, both with Truvada, and fared very well.

If I had been infected as recently as you my biggest dilemma would be whether to go ahead and start ASAP or wait until my numbers got to the point that most people start, be it 350 CD4s or 500, etc. which means you could go years without HIV meds and the longer one goes the better and better the drugs are bound to get. On the other hand, there are studies looking at the advantages of starting very early, within the first year of infection. It's been shown that reservoirs are significantly smaller in those who start that early and there is the possibility of going on treatment interruptions in the future, without the usual dangers that they involve,
« Last Edit: July 01, 2009, 03:13:47 AM by Inchlingblue »

Offline CallMeSid

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  • Member
  • Posts: 90
Re: low viral load at 6mos
« Reply #7 on: July 05, 2009, 03:32:21 PM »
Like you, my VL was low when I first tested positive and my infection was relatively recent (within the last year).  Two years later, my VL has remained pretty low and my CD4 count/percent has remained pretty stable without meds.  Here's hoping that your numbers will follow a similar pattern!

A question for you:  I was surprised to hear that you had a viral genotype test done when your VL was 300-400ish.  I was under the impression that a VL of at least 1,000 was necessary for a reliable genotype test.  Is that not the case?

07/2006 HIV-negative
06/2007 HIV-positive
07/2007 CD4: 795 (40%), VL: <50
09/2007 CD4: 629 (43%), VL: 895  (~2 weeks after measles/mumps/rubella booster)
12/2007 CD4: 854 (45%), VL: <50
03/2008 CD4: 880 (45%), VL: 151
12/2008 CD4: 943 (46%), VL: 116
05/2009 CD4: 865 (44%)  VL: 107

Offline indigolime

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  • Posts: 8
Re: low viral load at 6mos
« Reply #8 on: July 05, 2009, 10:04:31 PM »
When I found out I was positive, the office manager for the doctor I chose ordered the viral count with the genotype since I was concerned about resisitant strains, and I asked if there was a test for this. 

I'm now aware a drug naive person with a vl<50 is an elite controller, vl<2000 a viral controller, that is if the count remains in that range over time.    There is a 5% chance someone will be a controller, so I'm guessing she figured the odds were that the test would be accurate. 

However the doctor didn't mention the genotype would not be accurate due to the low viral count.   The person I likely inherited this from should have his genotype this week.   I'm now wondering if the tests will be comparable.   His count was 70,000.  I was hoping to compare our genotype tests to put some of the pieces together about our seroconversion, not that it matters really.
12/08: negative
likely infected 12/08-3/09
6/4/09:   positive
6/09:   cd4 617;  36.4%;  vl 379
9/09:   cd4 579;  33.1%;  vl 3730
12/09: cd4 558;  31.0%:  vl 1880
4/10:   cd4 500;  30.0%;  vl 3890
     Isentress/Truvada started 4/19/10
6/4/10:  cd4 518; 32.0% vl undetectable

Offline mewithu

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  • Posts: 160
  • mewithu
Re: low viral load at 6mos
« Reply #9 on: July 05, 2009, 10:49:51 PM »
 I think you very best interests you need to drop this Dr. and Get an authorized Infecectios Desease Dr' and have him get the reports and all paperwork from this dr's office.
 Then you need him to thoroughly set with you and the paper work and find a better plan thyou can follow.
 It is to your best interests that you do this so that at this early stage in the desease your body has fight chances later on if you end up with resistance to a particular drug or drugs. Starting you on the high end medicine may not be in another Doctors idea of treatment at all.
 You have the choice to get referals to see other Doctors my friend and don't be shy or intimidated to leave thi Doctor.
 Someone in a hospital must have registries that have referals to Infectious disease doctors. Good ones too.
 It is your body dom't let them messs around with it my friend.
1997 is when I found out, being deathly ill. I had to go to the hospital due to extreme headache and fever. I fell coma like,  two months later weighing 95 pounds and in extreme pain and awoke to knowledge of Pancreatis, Cryptococcal Meningitis, Thrush,Severe Diarea,  Wasting, PCP pneumonia. No eating, only through tpn. Very sick, I was lucky I had good insurance with the company I worked for. I was in the hospital for three months that time. 
(2010 Now doing OK cd4=210  VL= < 75)
I have become resistant to many nukes and non nukes, Now on Reyataz, , Combivir. Working well for me not too many side effects.  I have the wasting syndrome, Fatigue  . Hard to deal with but believe it or not I have been through worse. Three Pulmonary Embolism's in my life. 2012 520 t's <20 V load

Offline mewithu

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  • Posts: 160
  • mewithu
Re: low viral load at 6mos
« Reply #10 on: July 05, 2009, 11:39:42 PM »
 First of all the numbers you are reading are in very small quantitys of blood very small. You wil have to look it up to get the actual amount because I forgot,but for example I believe it is like a end of a teaspoon or less, I really cannot remember to tell you the truth. On the other hand it means you really have a lot of virus running about in your body even when they say 75 parts per million or somthing like that. They are only testing a very small, I mean smal amount of blood when they get these results.So you are still infected with the virus when they tell you are undetectable.
 Don't get me wrong having a small amount still running around in your body is good news as far as things go physiology speaking. This keeps your Cd4 and cd8 and so on on the higher side hopefully, 300 and higher are good numbers as far as that goes. The higher your defence cells cd4 are the better.
 This is a lot to through at you all at once.By the way Cd4 and cd8 cells are tinyy amounts they measure also. You have many of these in your body on both sides when they test. they just try to keep the harmful viral load low so the cd4 ancd8 have a fighting chance at fighting Opertunistic infections
 I hope any of this has helped you.
 My main point was to get you to a Dr who will battle this disease with you not against you.

Thank you if you made any since of this.

Sincerely,
Jerry
1997 is when I found out, being deathly ill. I had to go to the hospital due to extreme headache and fever. I fell coma like,  two months later weighing 95 pounds and in extreme pain and awoke to knowledge of Pancreatis, Cryptococcal Meningitis, Thrush,Severe Diarea,  Wasting, PCP pneumonia. No eating, only through tpn. Very sick, I was lucky I had good insurance with the company I worked for. I was in the hospital for three months that time. 
(2010 Now doing OK cd4=210  VL= < 75)
I have become resistant to many nukes and non nukes, Now on Reyataz, , Combivir. Working well for me not too many side effects.  I have the wasting syndrome, Fatigue  . Hard to deal with but believe it or not I have been through worse. Three Pulmonary Embolism's in my life. 2012 520 t's <20 V load

Offline madbrain

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  • No longer an active member
    • My personal site
Re: low viral load at 6mos
« Reply #11 on: July 06, 2009, 05:58:04 AM »
A question for you:  I was surprised to hear that you had a viral genotype test done when your VL was 300-400ish.  I was under the impression that a VL of at least 1,000 was necessary for a reliable genotype test.  Is that not the case?

I had a VL of 698 when I first tested positive, and I had a genotype done as well, and there were no issues with it - and no drug resistance. It was ordered my by my my primary doctor who is an HIV specialist. My bf, who had a higher VL, also had a genotype done, and it mached mine. So, it must not be the case that you need a 1000 VL for the genotype test to be done or be accurate.
« Last Edit: July 06, 2009, 06:00:35 AM by madbrain »

Offline madbrain

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Re: low viral load at 6mos
« Reply #12 on: July 06, 2009, 06:04:16 AM »
I think you very best interests you need to drop this Dr. and Get an authorized Infecectios Desease Dr' and have him get the reports and all paperwork from this dr's office.

Authorized by who ? He said he was seeing an ID doctor already.

Offline madbrain

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Re: low viral load at 6mos
« Reply #13 on: July 06, 2009, 06:13:31 AM »
Hi indigolime,

After 23 yrs of testing negative I tested poz on 6/4/09.  I was mortified and didn't really feel human again until I found this site around 6/19 and started following these posts.   Reading about your experiences has brought me back to life over the last few days.   Thanks so much for sharing your knowledge and for your encouragement.

Sorry to hear about your new infection, but glad you found us.

Quote

I saw my "ID" for the first time yesterday.  He was enthusiastic because my viral load was "very low" at 379.   He told me there are some people who never need meds, that they have a natural resistance to the virus, and that I may fall into this category. 

It is good news. 379 is very good. I initially came in with only 698 VL also and my doctor was enthusiastic as well. I couldn't really believe the outcome would be good for a while. But almost 3 years later, my VL is even lower and I'm in a study as a viremic controller.
Remember to get your labs done regularly still. This is only your first of many sets of numbers. Your VL and your CD4 will go up and down. The trends are important.

Quote
Can the virus do damage at these levels?   
 

The short answer is yes. But I don't know all the details. I really should press my doctor more.
Here is one, about artherioscleriosis  http://www.aidsmap.com/en/news/F0AD4367-ECE6-4767-A6EA-BE8133E779B5.asp

Not trying to scare you off, just giving you the honest answer. So far I have made the decision to be off HAART still even knowing this.

Offline Inchlingblue

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Re: low viral load at 6mos
« Reply #14 on: July 06, 2009, 05:22:48 PM »
  Can the virus do damage at these levels?   

There is more and more evidence that starting soon after infection can have a lot of benefits. Here is one more to add to that, "Early Antiretroviral Therapy May Protect against HIV-related Brain Dysfunction"

LINK:

http://www.hivandhepatitis.com/recent/2009/070609_b.html

Offline indigolime

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  • Posts: 8
Re: low viral load at 6mos
« Reply #15 on: July 08, 2009, 11:37:08 PM »
Shit. My friend's genotype came in and his virus is resistant to the entire NRTI class.   

Looking at mine again:  NRTI's Resitance Associated RT Mutations - "no relevent mutations detected".   For PR mutations for PI's: "resistance I15V, M36I, L63P".

On 6/24 all my ID doc told me was none of the mutations are relevent, and none of the current combination drugs are ruled out.   Not the case with my friend whose doc ruled out Truvada and Atripla.  This is effing confusing.    So, yea, if we share this virus (very likely) my results aren't accurate, and my doc isn't working this month to answer my questions. 
12/08: negative
likely infected 12/08-3/09
6/4/09:   positive
6/09:   cd4 617;  36.4%;  vl 379
9/09:   cd4 579;  33.1%;  vl 3730
12/09: cd4 558;  31.0%:  vl 1880
4/10:   cd4 500;  30.0%;  vl 3890
     Isentress/Truvada started 4/19/10
6/4/10:  cd4 518; 32.0% vl undetectable

 


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