Partial treatment failure or "dead virus" from reservoir?

[mecch]

Here's a new one:

Saw my ID today and he said that I should have been undetectable by about Christmas 08. He said (in French) - soit echec partiale, soit ils sont sorti de la reserve mort.  In English - since I started HAART with stratospheric viral levels, he said he has seen a few times people who are effectively on HAART (the virus has been reduced to the reservoirs, only,) and yet they are not "undetectable" beause the very small (in the hundreds) of viremia they measure in the blood is actually dead virus. 

Has anyone ever heard of that? And reference in the literature?  I thought the virus in the reservoir was NOT dead. So the idea is that I'm releasing a lot from the reservoir which dies on arrival in the blood stream, with HAART present.

I asked him to explain, if there were tests - he said yes there is a very sophisticated expensive test and he wasn't going to do it because it didnt matter and was too expensive.  In those instances, it was impossible to cultivate the virus, it was effectively dead and had been released from the reservoirs.

Or, he said, I could have extremely low level resistance (bad news) -- but my viral load is just too low to test it, so he switched me to a newer class of NNRTI - from Sustiva to Intelence. 

The concern is that if I am not proven undetectable, I could ever so slowly developing resistance.

By the way, he wanted to put me on a old PI that has Lipo risks and then he called another specialist and said put me on newer NNRTI since Sustiva/Truvada (Atripla) seems to almost do the job.

I am discouraged. But hopeful eventually it will work out.

Well, I think I will do some mind body spirit hocus pocus because all these combos seem to work very well but I haven't yet found the "killer application" - maybe something esoteric could help?

Best to all

[Assurbanipal]

Yes there are references to it taking longer to get an undetectable viral load if you start with very high levels.  (I had the same issue, although my ID doc didn't talk to me about it.)

Here's what the US treatment guidelines say:
"Virologic suppression can be defined as a sustained reduction in HIV RNA level below the assay limit of detection (e.g., 50 copies/mL). Virologic failure is best understood in the context of virologic success; that is, virologic failure is defined as the inability to achieve or maintain suppression of viral replication to levels below the limit of detection (<50 copies/mL) and may manifest as any of the following:
• Incomplete virologic response: Two consecutive HIV RNA >400 copies/mL after 24 weeks or >50 copies/mL by 48 weeks in a treatment-naïve patient who is initiating therapy. Baseline HIV RNA may affect the time course of response, and some patients will take longer than others to suppress HIV RNA levels. The timing, pattern, and/or slope of HIV RNA decrease may predict ultimate virologic response [7]. For example, most patients with an adequate virologic response at 24 weeks had at least a 1 log10 decrease in HIV RNA copies/mL at 1–4 weeks after starting therapy [8-10].
• Virologic rebound: After virologic suppression, repeated detection of HIV RNA above the assay limit of detection (e.g., 50 copies/mL)."

http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf     p. 53 (60th page of the pdf file)

From your sig line looks like you are under 400 in 24 weeks. 


Overall sounds like you have an attentive doctor.

[newt]

I think you have smart doc - mattt

[mecch]

Cool thanks. Yeah he's supposed to be tops in Switzerland.