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Author Topic: So close to undetectable...but just not yet!  (Read 1795 times)

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Offline hermes

  • Member
  • Posts: 22
So close to undetectable...but just not yet!
« on: August 26, 2009, 12:00:37 PM »
Hey guys - just got back from my doctor and I guess I'm freaking out a bit. I've been on Atripla since the end of March of this year and I've had a fantastic response to it. I went from an almost 350,000 VL to 500 VL in just a few months.

My last two VL tests have been just on the threshold of undetectable. First one in mid July was 51 and now this one in mid Aug is 52. My doctor has said that sometimes he sees this with the last bits of virus in the system and that sometimes it just takes a bit longer to get there. Should I be concerned at this point? Is this pointing in the direction of possible resistance already? Is there anything I should be doing or taking extra to try and get this thing to under 50? Any advice, reassurance or comfort would be appreciated.

Scott




Offline BlueMoon

  • Member
  • Posts: 665
  • Calling from the Fun House
Re: So close to undetectable...but just not yet!
« Reply #1 on: August 26, 2009, 12:58:03 PM »
Welcome to the club.  I had four quarterly results between 51 and 66, before finally getting undetectable at my most recent lab.

Keep at it, you'll get there. 
...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
02/10-- ......<48.....481.....44
10/09-- ......<48.....277.....46
07/09-- ......<48.....300.....38
05/09-- ........51.....449.....39
03/09-- Added Isentress
02/09-- ........65.....299.....34
11/08-- ........62.....242.....40
08/08-- ........66.....212.....29
05/08-- ......202.....217.....27
03/08-- ....5210.....187.....21
02/08-- Began Truvada/Reyataz/Norvir
12/07-- 273,000.....157.....22
11/07-- 229,000.....209.....22
10/07-- Diagnosis

It's a complex world.

Offline dixieman

  • Member
  • Posts: 889
Re: So close to undetectable...but just not yet!
« Reply #2 on: August 26, 2009, 01:19:13 PM »
Hermes, Don't worry about it... the tests are most sensitive than in the past so the numbers can vary... your doing great...

Offline mecch

  • Member
  • Posts: 12,062
  • red pill? or blue pill?
Re: So close to undetectable...but just not yet!
« Reply #3 on: August 26, 2009, 01:57:16 PM »
Take it everyday and wait, you'll get there.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline David_CA

  • Member
  • Posts: 3,246
  • Joined: March 2006
Re: So close to undetectable...but just not yet!
« Reply #4 on: August 26, 2009, 02:24:38 PM »
Take a look at my numbers.  It took me about 18 months to finally get undetectable.  I figure my virus is stubborn... just like the rest of me!  ;)  I bet you'll get there, it's just taking a bit longer than you'd like.  The meds are working, which is what we all want, after all.

David
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline CallMeSid

  • Standard
  • Member
  • Posts: 90
Re: So close to undetectable...but just not yet!
« Reply #5 on: August 26, 2009, 04:37:43 PM »
Can I ask a question?  Is there really a clinically significant difference between an "undetectable" (i.e. <50) viral load and VL of, say, 75 or 100 or 200 or [some other low number]?  A few years ago, most VL tests had a detectable cutoff of 400, so a level of, say, 200 back then would come back as "<400" or "undetectable" on the lab report.  Today, because of more senstive tests, that 200 would be considered "not yet undetectable" and lead to worry/consternation/frustration on the part of the patient and/or doctor and I need to ask:  is there really a clinically significant difference between "undetectable" and "just barely detectable"?  Or is the pursuit of "undetectable" VL result (vis-a-vis a very low but detectable level) more of a psychological thing, leading one to feel relieved that the VL is as low as it can go with respect to the currently available tests?

Part of my the impetus for my question comes from the fact that the fact that "viremic controllers" are those HIV+ individuals with consistent VLs below 2,000.  If <2,000 is considered "viremic control" (and a low chance for disease progression) for those not on meds, why isn't <2,000 viewed in the same light for those on meds.
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 BlueMoon

  • Member
  • Posts: 665
  • Calling from the Fun House
Re: So close to undetectable...but just not yet!
« Reply #6 on: August 26, 2009, 05:21:58 PM »
  If <2,000 is considered "viremic control" (and a low chance for disease progression) for those not on meds, why isn't <2,000 viewed in the same light for those on meds.

I think because of the high probability of those on meds mutating resistance. 

I think that is also why getting as undetectable as improving technology allows is stressed.  I was satisfied with my barely detectable numbers, even though the doc was getting antsy.  As long as they didn't go up I wasn't worried.  But the lower the better. 
...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
02/10-- ......<48.....481.....44
10/09-- ......<48.....277.....46
07/09-- ......<48.....300.....38
05/09-- ........51.....449.....39
03/09-- Added Isentress
02/09-- ........65.....299.....34
11/08-- ........62.....242.....40
08/08-- ........66.....212.....29
05/08-- ......202.....217.....27
03/08-- ....5210.....187.....21
02/08-- Began Truvada/Reyataz/Norvir
12/07-- 273,000.....157.....22
11/07-- 229,000.....209.....22
10/07-- Diagnosis

It's a complex world.

Offline newt

  • Member
  • Posts: 3,887
  • the one and original newt
Re: So close to undetectable...but just not yet!
« Reply #7 on: August 26, 2009, 05:38:00 PM »
Quote
Is there really a clinically significant difference between an "undetectable" (i.e. <50) viral load and VL of, say, 75 or 100 or 200

Yes and no...

Some modern tests are very sensitive, and what is 200 at 9am is 3 at 9pm

A viral load of less than 50 is the point where HIV goes to sleep according to much research, but the difference between 50 and 52 or 75 even is moot.  I note that a viral load of 200 is half a log higher than a viral load of 50, and half a log (a different way of counting numbers) is a significant  increase.  But viral load 150 is within the margin of error for viral load tests and could be 50 really...

So your 52, I wouldn't worry, 150 I wouldn't worry, 200 but always 200 or less I wouldn't worry, above 200-1,000 and part of a rising trend, I would worry.

- matt
"The object is to be a well patient, not a good patient"

Offline BM

  • Member
  • Posts: 340
Re: So close to undetectable...but just not yet!
« Reply #8 on: August 27, 2009, 08:52:45 AM »
Do lots of blips increase the chance of resistance?

Offline newt

  • Member
  • Posts: 3,887
  • the one and original newt
Re: So close to undetectable...but just not yet!
« Reply #9 on: August 27, 2009, 03:11:43 PM »
No

- matt
"The object is to be a well patient, not a good patient"

 


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