Perplexing encounter

[Turkmenbashi]

Newbie here.

The last year has been a rough ride. PCP pneumonia in November/06, HIV+ diagnosis soon after. CD4s were about 20 at the time, with viral load > 100K. Started HAART (Kaletra/Truvada/Zerit) in January, dropped the Zerit in March due to neuropathy.

Since starting HAART, my CD4s have increased to 130. My viral load was
700 in March/07
200 in April
150 in May

Needless to say I'm relieved and encouraged by the progress. That is, until yesterday. Was at the ID specialist's office and he said that he would have liked to see my VL undetectable by now and that the drop between April and May was not significant enough. He mentioned that this was more of a personal preference of his, but that we need to be concerned that the downward trend continues, as a plateau or increase could indicate resistance.

So I am confused and concerned. I have a medical professional telling me that this is potentially worrysome, yet to my layman's eyes, the falling numbers are a good thing. Does anyone have any insight into the pattern of VL reduction? How long does it generally take for the VL to be undetectable?

I'm not sure what to make of all this 'undetectable' business anyway. It seems the tests they use can detect a minimum of 50 copies. Would my doctor be concerned if, say, the lowest detectable number were 100? Conversely, if they came out with a newer test that could detect as low as 25, this would make a whole new group of people 'detectable'.

At this stage, I'm looking at the trend as an indication, as opposed to the numbers. What I would really like to know is if the *slowing* of my progress is an indication that resistance is building.

Thanks for all of your insights. This forum has been a great source of hope to me in the last few months.

James

[newt]

Hello

1. What was dimbo doc doing putting you on Zerit in the first place, Kaletra + Truvada is a perfectly good and strong combo

2. At viral load of 150 you maybe undetectable.  Viral load can be 3 x higher or 3 x lower.  A good first move would be to retest using a different lab, or a different test from PCR (like bDNA).

However, your doc is right to be cautious about resistance after 6 months.

- matt

[Buckster2005]

I would hold on.  I have been pos over 20 years and never had an VL <50 until just recently.  I started truvada and kaletra in Nov with a VL of 25k and multiple resistance and VL was 1120 in Feb and <50 in May.  Are you taking the tablet form?  I have very few side effects with this version.  Hope this helps.

[Miss Philicia]

I have been pos over 15 years and never had an VL <30,000 until just recently

[Turkmenbashi]

Thanks for the replies. I'm holding tight for now. I suppose my mid-June blood work will be indicative of what, if any, treatment changes to make. I'll be on pins and needles until then.

BTW, am on the tablet form of Kaletra. Few side effects, apart from the occasional stomach discomfort and diarrhea.

About the 'undetectable' viral load term, it seems to me that it is more an indication of the state of the technology rather than individual treatment progress. Obviously, the lower the VL number the better, but if the numbers are low and do not rise, I suppose I can live with that. Doc still seems to be intent on reaching this target, though.

[Tempeboy]

The most important thing is the continued downward trend.  The number is low, and means you should be undetectable soon.  My vl took a long time to reach undectable.  It turned out I had a long running chest infection that we thought was either side effects or a nasty flu.  This can apparantly effect results, as can other infections (sexual, gut etc).  Your doc even says he speaks to his own standards, which is great, but we are individual and therefore progress differently.

Remember that a retreating vl is a soon to be undetectable load.

xx

[trellium]

The sustained downward trend in your VL reduction is a good sign that the current meds are working.
The VL will drop A LOT very quickly during the first few weeks of starting meds, followed by a more gradual and slower decline over time.   
Don't let your doc's personal preference/agenda make you become his/her personal lab rat. 

Under DHHS guidelines, virologic failure is classified as VL of >400 at week 24, or >50 at week 48 of starting meds. 

For some, their VL gets <50 pretty quickly whereas for others it can take a while longer.
I'm on the same meds (Kaletra + Truvada) and got <400 at week 2 and undetectable (<50) at week 8, but some friends in the same clinical trial took 32 weeks to get there. 
There are special modified VL tests that can measure way below 50 copies, but they aren't commercially available.  I doubt the pharmas will be thrilled when the sensitivity bar is being raised again

Virologic failure: When to modify therapy
http://www.hopkins-hivguide.org/management/antiretroviral_therapy/virologic_failure__when_to_modify_therapy.html?contentInstanceId=8271&siteId=7151