Lab results

[Aldude2023]

Hello all! I have been positive for 6 years. Originally when tested positive was started on Genvoya and 1 month later I was undetectable. Every time I have had lab work done since that visit I have been undetectable until this most recent month. My lab work now shows detectable but less than 20. My doctor wasn’t worried about it and said that it would probably be undetectable again the next time it’s checked which he said would be 4 months. I keep worrying about this despite reading multiple articles/ websites that says not to worry. Has anyone experienced this and is this normal? I have maybe missed 1-2 pills the entire time I have been on treatment. When I had labs done I didn’t feel sick or have any vaccinations. Just wanting reassurance from others who has experienced this. Cd4 has remained over 1000 for the past 4-5years including recent labs.

[Jim Allen]

Hiya,

detectable but less than 20.

Thats undetectable. The term undetectable in the lab is different from treatment goals and passing in on. Undetectable as a goal does not mean 0 copies or undetected by the lab, and your doctor is correct. Nothing to worry about as the lab results show the virus is fully suppressed (Undetectable); it's below 50 and not even close to 200. That's the goal of the treatment, and the job is done.

Below 20 does not even count as a micro blip as it tends to be called on the forum.

Some transient micro blips like 50+ but below a couple of hundred are nothing more than detecting the low-level release of the virus from existing reservoirs, including defective copies. Hence it's not a concern with the treatment etc, and your labs don't even show that.

Has anyone experienced this and is this normal? I have maybe missed 1-2 pills the entire time I have been on treatment.

I suspect missing 1-2 pills over six years is better than most. It's a load better than myself and far above the 90-95% gold standard for treatment adherence.

Cd4 has remained over 1000 for the past 4-5years including recent labs.

CD4 is rather irrelevant once the VL is suppressed and the CD4 count is sable about 200. How are you otherwise feeling/doing?


"What’s All This Fuss I Hear About Viral “Blips”?

Blips
http://i-base.info/guides/changing/viral-load-blips

Viral Blips Don't Raise the Risk of HIV Treatment Failure
https://www.poz.com/article/viral-blips-raise-risk-hiv-treatment-failure

http://www.aidsmap.com/Spanish-study-gives-reassurance-small-HIV-blips-do-not-predict-treatment-failure/page/3085173/

What’s All This Fuss I Hear About Viral “Blips”?
https://academic.oup.com/cid/article/70/12/2710/5573119

Q&A on persistent low-level viremia.
https://www.healio.com/infectious-disease/hiv-aids/news/online/%7B8373ca63-674d-4015-ac35-f4da653c7415%7D/qa-understanding-persistent-low-level-viremia-in-people-with-hiv

[Jim Allen]

I'm not in favour of withholding results from patients, but I sometimes wonder if, in HIV care if more damage is done than good, and prehaps results should publish as "suppressed" as long as a result is below 200 on the reports so people don't shit themselves every time there is an irrelevant result.

[leatherman]

I'm not in favour of withholding results from patients, but I sometimes wonder if, in HIV care if more damage is done than good, and prehaps results should publish as "suppressed" as long as a result is below 200 on the reports so people don't shit themselves every time there is an irrelevant result.

undetectable is SUCH an imprecise, and confusing, result.

I think undetectable sounds like HIV is almost if not totally gone. We clearly know that's not true as latent HIV "hides" out in reservoirs in lymph nodes and other places. That's why we have to adhere to meds daily (or at least 90-95% of the time) so that as this latent HIV becomes active, it's immediately inhibited by the meds in our systems. Heck, when you think about it, that hardly even seems suppressed, does it? Much less "undetectable". But science has proven that a VL<200 does result in successful HIV suppression.

Then nothing is ever really stable in our bodies as it's always in a state of constantly moving. BP changes by minutes, along with heart rate. CD4s can bounce around by 100 pts a day. Blood sugar is up and down all day. So every result is nothing but a snapshot of that exact moment. A blip in the VL appearing in an 11am test but not in a 3pm test is completely possible. I think that doctors are just so used to this that they kind of shrug it off, not even realizing that a patient could be really worried if they hadn't had this kind of result before. Then, if you can see test results online, seeing that result highlighted as "out of range", "abnormal", "detectable" seems like just a reminder that something is wrong....when it's not.

Of course, this is why I always tell everyone that you need to think about these numbers by the trend of several tests over several months. For example Aldude, if you've always been UD, are now <20, and next test is UD again, if you graphed that out in a chart with even just 200 as the high point, your <20 result wouldn't even show as a blip because the change was so inconsequential.

[Mightysure]

They need you teaching ID at medical schools. Doctors don't realize that most of their patients aren't as studied as they are.