First Viral Load "Blip"

[Lou-ah-vull]

Well, after five plus years of "undetectable" viral load, I have my first "blip" of 40.  The doctor wants me to recheck in 3 months.  (I have been having six months checks for quite some time now.)

The good news is that for the first time in six years I have normal triglycerides:  132.  Normal cholesterol = 118.  Highest HDL in my life = 49.  I am pretty sure the large doses on niacin daily are the game changer here.

Two concerns.  My blood sugar was ungodly high at 241.  I will see my internist next week to be evaluated for treatment for diabetes.  I have been on the border of this with blood sugar for the past three years.  Also my C-Reactive Protein was way off at 20.6. (it should never be higher than 4 and has always been low with me.)  My ID doctor wants to recheck this too in three months after evaluation for diabetes.

The blip was unexpected but I have known for some time I was at risk for type 2 diabetes.  I will learn more next week.  Aging ain't fun! 

The blip of course has my attention, but thankfully I have read about them so much on here the past years and I know that one test is only enough to heighten concern.  I am fortunate my doctors are pretty aggressive about this.

Curious if any of you know what kind of treatment I will be facing about the blood sugar.  A bit surprised that with triglycerides normal for the first time since diagnosis that my blood sugar has spiked so high.  I always thought they were somehow related.

Gary

[buginme2]

The viral load of 40 is still undetectable in my book.  Based on your signature line your numbers are great.

Diabetes. A blood sugar result of 240 is pretty high.  Was this a fasting blood test or a random test?  If you ate before giving blood it could account for some of the elevation.

If you do have Diabetes step one would be evaluating your diet.  How is your diet? 

A common medication for diabetes is metformin.  Even with diet changes they will probably start you on it.

[Lou-ah-vull]

It was 12 hours fasting.  Over the last two years, I have been between 116 and 131 on blood sugar after fasting blood draws.  At the same time, I had high triglycerides, sometimes over 500, always over 330.  This test is the first time since diagnosis that I have had normal lipids, but this very high blood sugar test is troubling.  I have my annual physical in ten days and as supposed to have blood work again on Wednesday.  My internist is evaluating this information to see what, if any, blood work he wants to order (I am pretty sure he is going to want to test my blood sugar again.)

I know not to worry about that "blip" (although to be honest, I blanched when I first saw it) but I am concerned about the possibility of diabetes.

To answer your diet question, there is considerable room for change.  I am overweight by about 18 lbs and have made no attempt to regulate simple carbs and sugars.  I feel a "major change" coming on!

Gary

[newt]

Erm, look, 40 is not a blip on any viral load test, whatever your doc says. So rest easy.

- matt

[NY2011]

I agree. Don't make the next three months hell for yourself.  Your CD4 count is good and VL of 40 could very well be a blip.  I'm still fairly new to this, but after reaching undetectable on Atripla for the first time, my Cd4 went up to 140 the second time, and then back down to undetectable again two months later.

Thanks to you, Lou-ah-vil, I requested a hs-CRP test, and it came back at 4.1 which is the low end of high. I've been told that the number by itself doesn't mean much, but with a lipid panel and your blood pressure stats, I understand that it may be an indicator. 

I'm curious about your success with the niacin supplement that you recommended. What is your suggested dosage?  My meds are giving me high cholesterol numbers. 

[Lou-ah-vull]

I take six 500 mg tablets of niacin a day.  Two in the morning, two in the middle of the day, and two at bedtime.  30 minutes before taking niacin, I take either one full dose aspirin or ibuprofen.  This is necessary to prevent/reduce flushing (harmless, but highly uncomfortable.)  Nothing else has worked the way niacin has worked especially to bring down my very high triglycerides and to raise my HDL cholesterol.

Gary

[sanitex]

H! LOu-ah-vull  anyway i don't have much to say but a bit contribution and it work
for me. i even wrote to Dr Nelson  at thebody .com he comfirmed it .
so try to buy Apple cider vinegar brand name (Bragg)drink it everyday three times
 a day you'll see the impact even your cholesterol,LDl,HDl,triglycerides ,will improve better than before,for glucose that's for sure within one week it will subside  your level to normal thakx

[jkinatl2]

H! LOu-ah-vull  anyway i don't have much to say but a bit contribution and it work
for me. i even wrote to Dr Nelson  at thebody .com he comfirmed it .
so try to buy Apple cider vinegar brand name (Bragg)drink it everyday three times
 a day you'll see the impact even your cholesterol,LDl,HDl,triglycerides ,will improve better than before,for glucose that's for sure within one week it will subside  your level to normal thakx

Yes. I am sure that drinking vinegar will be the solution.

[Lou-ah-vull]

Egad.  Right up their with cod liver oil.  Thanks...but no thanks!

[eric48]

The viral load of 40 is still undetectable in my book.

I recently had a Research Hosptal VL trest in facility that measures down to 40. (the other lab I use goes down to 20)

the lab results was interestingly written is a very instrumentally correct way:

VL : origin: plasma
VL <40
Comment: the VL was detectable but below the level of quantication (40 copies/mL)


I will ask my doc if he has ever seen comments like : VL was undetectable
This would certainly happen if the technician verifies his machine with and un-infected blood sample, which, I would think may be part of instrumental procedure.

Many people misuse the term UD, they should either use < XX or BLQ

Eric
(who also misuses the term UD for anything below 50 or similar)

[bocker3]

I don't think that the term "undetectable" is misused, rather it is misunderstood.

If the assays lower end is 40 (or 20 or 50 or whatever) -- "undetectable" means that there is insufficienct virus to be detected by this assay.  Whether it is "present" in some volume below the assay's limit or is actually zero, is "unknonw", because you can't trust any reading below the assay's limit.  It might "read" 36 and actually be 0.  There is a reason for the low end limit -- it is the limit that can be "trusted".

Gary --
Hang in there -- I see no real difference between 40 and <40.  Of course, that is easier for me to say than you to internalize.
Looking forward to seeing you in a couple of weeks and hearing all about Alaska.

Hugs,
Mike

[leatherman]

I see no real difference between 40 and <40

considering just about 2 or 3 yrs ago "undetectable" was considered less than 200; and just a couple of yrs before than undetectable was <400**, IMHO anything <100 is still not much of anything these days. as has been mentioned "undetectable" doesn't mean "no HIV"; it just means below the limits of this test.

(**in both cases because that's as low as the test could score. Now some tests score <20 and some are <10!!)

[Lou-ah-vull]

My assay goes as low as 20.  I am not that concerned about the viral load (although, you are correct that "I don't like it') but I am quite worried about my blood sugar and the possibility of the diabetes diagnosis.  I am not sure what "life changing" circumstances await me if I have type 2 diabetes.  Trying to read about it now, but like anything else medical, you can really get yourself worried when you start researching on your own on the internet. 

I am guessing they are going to retest by fasting blood sugar this week and then take the next step.  It's that "next step" that is worrying me....

Does anyone know much about type 2 diabetes and more importantly, how it relates to HIV treatment?

I always appreciate the support!

Gary

[newt]

In the UK, when using the Roche test that measures to <20 copies, a reuslt of 200 or under is usually considered "undetectable" (flaky test for some reason). Officially, the line is doctors must decide what counts, but 200 is the working cut-off used for this particular test.

- matt.

[wolfter]

Gary, sorry to hear you're also dealing with this issue.  I always had horrible lipids also and after getting them under control, I suddenly started having high blood sugar levels. 

My doctor order additional testing, I think it's a molecule enyme test, that is a truer indication of the risk of diabetes.  Not sure if that's the true name of the test, but it's something like that.  I certainly don't want to add this disease into the mix either.  There's nothing else dietary that I can change.

I've bounced from being UD to small detectable levels for quite a while.  My doctor assures me this is not an issue and even the sensitivity of the tests can cause it.

[Lou-ah-vull]

My doctor called this afternoon.  On Wednesday morning I am going to have blood sugar rechecked (fasting of course), A1C (has never been checked before) and something about liver and kidney enzymes (I wonder if that is the test you had Wolfer.)

I really should quit reading all this stuff on the internet because I just simply don't have enough hard information.  All it does is increase my anxiety.

Still very appreciative of any suggestions you guys have.

Gary

[joeyg624]

for many years, a VL below 70 was considered as undetectable... with more sophisticated instruments these days, the threshhold for being undetectable has gone down to below 20... this is probably why a VL of 40 is showing up in your last test.

[Miss Philicia]

Actually, if I recall correctly, viral load was <400, then <200, etc. The test has been around for 15 years.

[bocker3]

I recall in the earliest days of the test it was <10,000 - I was responsible for calling these results to ordering clinicians for a large HMO network in Boston back in the late 90's. 
That test has come a long way............

M

[Common_ground]

I recall in the earliest days of the test it was <10,000 - I was responsible for calling these results to ordering clinicians for a large HMO network in Boston back in the late 90's. 
That test has come a long way............

M

Thats amazing!

[eric48]

I will ask my doc if he has ever seen comments like : VL was undetectable
This would certainly happen if the technician verifies his machine with and un-infected blood sample, which, I would think may be part of instrumental procedure.

Many people misuse the term UD, they should either use < XX or BLQ

The following article :

Factors associated with a strictly undetectable viral load in HIV-1-infected patients.
http://www.ncbi.nlm.nih.gov/pubmed/22435457

Somehow anwers the question:

The authors have classified 3 groups:
- strictly undetectable
- detectable but below <20
- detectable but > 20 and <50

My latest lab results say detectable but below <LoQ (which is 40 in that location: hospital) ( my other lab results simply say <20, when performed in another location: commercial , private lab)

Apparently there is a group of patients that are strictly undetectable and that group can be distinguished from an other group : detectable but below <20.

Obviously, clinical pratice in well equiped labs can differenriate between SUD and what is usually refered to UD in many publications and documents, i.e. Below LoQ

Hope this clarifies things

Eric

[elf]

You should stop taking niacin, since it has been linked to causing high blood sugar.
There are other options like omega-3 that can lower your triglycerides efficiently without affecting blood sugar.


Severe reversible hyperglycemia as a consequence of niacin therapy.
http://www.ncbi.nlm.nih.gov/pubmed/8357290

I took niacin for 6 months, and although it made my HDL go high,
the blood sugar and liver enzymes got sky high as well.
It took me 3 months to bring them down to the normal values.
Now my HDL is not that high, but HDL is the least important factor in your lipid profile (total cholesterol and LDL being much more important).

[Lou-ah-vull]

Wow.  First time I have seen this.  I will be seeing my doctor on Friday and I will present this information to him.  It may explain why I had dramatic improvement in my lipid profile (all across the board) but a dramatic and unexplained rise in fasting blood glucose (from a borderline high 115 to 241.)  This is very helpful.

I will post what I learn from my doctor.

Gary

[Lou-ah-vull]

Update-

I saw my regular doctor for my annual physical on Friday and to review rechecked blood work regarding my elevated blood sugar.  On the retest I declined from 241 to 200, but obviously that is still high.

As others have suggested, my doctor thinks the most likely culprit is the 3000 mg of niacin I have been taking daily to improve my lipids (which it surely did.)  So, I am completely stopping the niacin for 30 days, retaking fasting lipids and blood sugar to see what happens.  Although I feared it, the doctor thought it was too soon to make a diabetes diagnosis.

If nothing else, this gives me permission to drink (and I don't mean water) while at AMG this week!

Gary