Increase in CD4 and also in viral load

[+/-]

Good morning all,

I'm here again confused about the numbers! Just got my last lab results which were taken in October, CD4 464, VL 167. Since I started treatment, almost 2 years ago I have reached the undetectable level once, that was way back to December 2011.

Since then both the CD4 and VL numbers kept fluctuating. I'm not concerned about my CD4 since it never went down the 300's but on the other hand I am worried that my viral load keeps increasing. Tests were taken in a 3 months period, last test being done after 2 months and my VL results were as follows:

April 2012: 83
August 2012: 123
October 2012: 167

First and second tests were discussed with my ID doctor and he mentioned blips which I knew it could happen but 3 blips in a year, I find that very strange and not very convincing.

Also, my last lab results indicated that my CD4 increased to 464 as opposed to 310 in August. Although this is good, it is still confusing since usually as the CD4 increases the viral load decreases.


Such numbers are freaking me out!

Any words of advice would be much appreciated, please.

Thanks!

[weasel]

   Hi   +/-  ,

                     Your viral looks OK  , that is not a bad number .

    I do hope you do not worry yourself too much .

         
                                    be well .   

                                                          Carl   

[+/-]

Hi Carl,

Thanks for answering my question! i do know that a VL of 167 is OK however it is still not undetectable and my concern is that although in small figures, it just keeps going up.

[Miss Philicia]

Hi Carl,

Thanks for answering my question! i do know that a VL of 167 is OK however it is still not undetectable and my concern is that although in small figures, it just keeps going up.

I agree it's maybe unusual, but not unheard of -- and you have to realize that it's only gone up about one log. Viral load increases/decreases aren't based on absolute numbers, so while it looks like it's doubled, it's really only increased by "1"

read this

All of these results would have been considered undetectable just a few years ago, because they could only count viral load down to (IIRC) 400. Is your doctor freaking out? Doubtful. So then you shouldn't be either.

[MilburnCreek]

Your viral load is still damned low...you should feel good about your overall control.

Did you have any brief illnesses, infections, or colds since your last test?  Sometimes VL will bump up a little bit simply because of other stuff going on.

[newt]

A small percent of people never reach undetectable, and it don't seem to matter.

But, me, I'd want an immediate retest on viral load, resistance test and then a discussion about a new combination using at least one different class of drugs if the viral load retest was still over 50.

- matt

[+/-]

Hi all,

First and foremost, I would like to thank all of you who replied to my question. Had a private appointment with my ID doctor and he decided to change one of the meds I'm currently on, the Sustiva. He suggested that I should switch to a protease inhibitor and go on Kaletra which according to the doctor is a more potent drug.

To be honest, such a switch made me feel a bit sad reason being that I will have to take more pills - 2 (Kaletra) + 1 (Combivir) in the AM and the same regimen in the PM. Also, I have read that the one of the side effects of the Kaletra is diarrhea however he told me that most of the patients tolerate Kaletra very well and the diarrhea should subside within weeks.

Anyone of you was on Kaletra and had any issues related to side effects?

Hope this drug will be the virus and I'll reach the undetectable level very soon.

Once again, thanks for listening and for giving your feedback.

[wolfter]

Anyone of you was on Kaletra and had any issues related to side effects?

You will find people that have issues with every combo available so I'd be careful to avoid concentrating on that.  The only way you'll know is to try and see how it works for you.  Through the years I've been on numerous combos and for me,the Kaletra and Combivir combo was one of the worst.  For ME, it was horrid but that doesn't mean you'll experience the same thing.

Did he perform a resistance test?  Just asking as I didn't think this particular combo was prescribed that often any longer.  I could be wrong which has been known to happen.

Take care and best wishes.

Wolfie

[eric48]

There is a research study by Siliciano (*) that went into deep sequencing and shows that in the course of treatment history, at some point of time some resistant variants will (almost inevitably) occur.

It also shows that these mutants are not strong enough against the other meds in the combo (which is why we need 3...) and will eventually disappear.

Mutations appear at a cost of viral fitness. and in survival of the fittest, confronted with 3 potent meds, it is difficult for them to survice on a long term basis.

on the other hand, should they survive that darwinian rule, then they take over and you are heading for viral failure. Which is rare, if you are adherent.

Your options are open:
- wait (stay 100% adherent) and see
- switch and stay on new combo if you can live with it
- switch and wait, and switch back after, say, 6 months or one year, if you would prefer the original combo.

quote from Pr. Siliciano's article here:
https://www.iasusa.org/sites/default/files/tam/13-3-96.pdf
(quote)
blips that are greater than 200 copies/mL or reproducible on independent or sequential testing are a greater cause for concern
(end of quote)

If the next reading is over 200, I'd go for a switch.
BTW, you can't really have a reliable resistance test unless VL is > 500 at the very least (some people say 1000...)

(*) Genotypic Analysis of HIV-1 Drug Resistance at the Limit of Detection: Virus Production
without Evolution in Treated Adults with Undetectable HIV Loads
http://www.ncbi.nlm.nih.gov/pubmed/15073683

Hope this helps

Eric

[Fisher]

I am new to this forum so I am not sure if I am even responding appropriately.  But anyway, please do not fret. From what I know, whether accurate or not, although it seems like an significant increase in VL, there is essentially no difference at all, between your first and third VL,  not to mention the second.

Your VL is a single snapshot at what is happening inside you at a pin point in time. Of course it varies. But the variation between the counts is just incredibly small, although it may seem huge. And if I had three tests rising, I would find it disconcerting, too, and be freaking a little, actually lots.  But divide any of those numbers by 100,000, 250,000 or 500,000 and you will find no change whatsoever.

-fisher

-fisher