Re: Confused about new lab results Undetected or not?

[fish grass]

New on POZ forums and coming into this thread rather late, so I'll continue looking for more recent threads. But meanwhile, if Jim or anyone else knows, is there any discussion about why someone would have persistent elevated viral load, though still UD? The labs I go to have been resulting in <20 for years, but this past year my VL has hovered between 23-51 copies/mL. I should say the 51 VL was when I had a blood draw too soon after a COVID vaccine, so I'm told that will elevate results for 2 weeks or more. But my last blood draw was MONTHS past any vaccine, I have 99.99% adherence (skipped 1 dose since becoming poz in 2015). That said, I sometimes take doses a few hours late, but I'm told after holding UD status for so many years, there's enough residual medication in my body that a few hours won't matter.

Otherwise, I'm in fairly good health, non-smoker, nothing very stressful in life... My last test was:
VL: 48
CD4: 1,271 /ul

[Jim Allen]

VL: 48
CD4: 1,271 /ul

Congratulations, your viral load is fully suppressed; it's not elevated.

I also moved your post into its own thread, as we don't post our issues in other people's threads.

[Jim Allen]

How are you feeling and doing otherwise?

I have 99.99% adherence (skipped 1 dose since becoming poz in 2015). That said, I sometimes take doses a few hours late, but I'm told after holding UD status for so many years, there's enough residual medication in my body that a few hours won't matter.

That would be the case after 20 or so days, let alone years. A few hours will make no difference with the current first or second-line combinations of HAART.

What HAART combination are you taking, and how are you finding it otherwise?

is there any discussion about why someone would have persistent elevated viral load, though still UD?

You didn't switch treatments, did you? Also, what did your doctor say?

There was plenty of discussion and studies, including that defective HIV copies released from the reservoir are counted incorrectly in the VL. (transient blips) More common in people with a larger viral load when starting treatment, and that's still the majority of us.

Anything under 50 copies, I would not even call a blip; I mean, that's the result they look for in studies into treatment effectiveness, and anything under 200 is prehaps a micro blip but UD.



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

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/

TaSP U=U
https://forums.poz.com/index.php?topic=71864.0
(*undetectable viral load defined as less than 200 copies/milliliter)

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


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943894/
Adherence and virologic outcomes among treatment-naïve veteran patients with human immunodeficiency virus type 1 infection

A cohort study was conducted on HIV veterans initiating antiretroviral therapies in 1999 to 2015

In summary, this study showed how initial adherence differently influenced the viral suppression rate across different regimens. No evidence shows 95% adherence threshold is necessary. Patients with medium adherence (75%–<95%) can achieve viral suppression with the rate not statistically significantly different from patients with high adherence.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839839/
Adherence to Antiretroviral Therapy and Virologic Failure

Paterson et al suggested that at least 95% adherence to unboosted PIs was required for virologic suppression. This 95% adherence cut-off point, based on what is now obsolete therapy, has been widely used as the level of optimal adherence needed to be met by patients taking newer agents and their combinations.

This meta-analysis synthesized 43 studies (27,905 participants) performed across >26 countries, to determine the relationship between cut-off point for optimal adherence to ART and virologic outcomes.

Irrespective of the cut-off point for optimal adherence, our findings support the tenet that optimal adherence to ART is associated with positive clinical outcomes. The threshold for optimal adherence to achieve better virologic outcomes appears to be wider than the commonly used cut-off point (≥95% adherence). Though patients taking ART should be instructed to attain ≥95% adherence, apprehensions of slightly lower adherence should not deter prescribing ART regimens at an early stage of HIV infection.


https://journals.lww.com/jaids/Abstract/2019/11010/Antiretroviral_Adherence_Level_Necessary_for_HIV.3.aspx

Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data

A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression.

Results: The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively.

Conclusions: The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.

[fish grass]

Thank you so much for this reassuring information. Some excellent articles I’ll want to read.

I’ve been on Triumeq since I first began treatment in 2015. Since my last test with the (not really) “blip” my PCP changed networks. Before she left we discussed other health conditions happening at the time that may have resulted in the “blip”. I get my blood work up end of May and establish care with a new provider. I’ve been feeling perfectly fine this whole time so I’m hoping for <20, which is what I’m used to.

[harleymc]

Any update?