Is this normal?

[blackbeauty40]

Hello! I know someone that is not taking meds and hasn't been for a few years. I will say that they do have a viral load, but their viral load is increasing really slowly. They gave me the ok to give their numbers. From what he says, his current viral load is 420, in May of 2020, his viral load was 386, and in January of 2020, it was 242. I've been telling him to get on meds, but he doesn't want to listen. My question is, is it normal for someone's viral load to increase this slowly? He's been off meds since 2018.

[Jackmydin]

That's something new I learn from you today.. But I guess different people react differently based on their body immunity. Usually I thought the virus load would bounce quickly..

What concern me is that why isn't he back on meds, and can he still get back to his old regime? Wouldn't the virus starting to develop some sort of resistance already?

But I hope friend is doing fine and healthy. After all its on their own hands for them to make the decision.

[leatherman]

Wouldn't the virus starting to develop some sort of resistance already?

it depends on how this person stopped taking meds. Resistance mostly happens when someone begins to erratically take their meds. While staying adherent, the level of meds remains high enough to stop HIV from replicating (as it does when our own hidden reservoirs occasionally start producing HIV). If the level of meds dips below a certain threshold, there is not enough meds in your system to kill off all replicating HIV, so some HIV becomes resistance to the med and is able to replicate unchecked (until meds are changed to something different)



As time goes by after taking a dose of meds, the level of those meds starts high and begins to decrease. The next dose bumps the levels back up. Keeping the med level in the optimal zone keeps HIV in check. While missing one dose rarely brings about resistance (95% adherence is the lowest goal for successful treatment), if doses are missed haphazardly, the level will dip again and again below the minimal level, and HIV will have opportunities to develop resistance to the meds.
https://i-base.info/guides/art-in-pictures/drug-levels-and-adherence

can he still get back to his old regime?

perhaps. it all depends on if resistance developed. If a person simply quits meds, the med level will not only drop below the minimal level; but will drop to 0.... which means there would be nothing for HIV to become resistance to. So the old regimen could still be viable. A genotype test is used to see which meds still work and which ones HIV has become resistance to. Genotype tests have usually needed a high enough level of viral load to be able to properly test but newer genotyping has been developed to not need a high viral load.

I guess different people react differently based on their body immunity. Usually I thought the virus load would bounce quickly..

there are too many variables to determine rebound time. Had HIV been suppressed long enough that the HIV had mostly become dormant in the reservoirs? How strong is the person's immune system? How virulent is the person's strain of HIV?

personally, I have had to quit meds twice (in the old days with harsher meds, resistance issues more prevalent with less effective early meds, waiting for new meds to come to market. Ah. the bad ol' days. You kids today will never will in a world where there were less than half a dozen ARVs and if you developed resistance you were f*ked until somebody invented something new. What was worse, was when that something new wasn't much better (or worse!) and you ended up with other issues.) Both times, my viral load stayed very low <500 for 6 months or so - before dramatically rising and ending up with me in the hospital at the 9 month mark with AIDS and opportunistic infections.

My question is, is it normal for someone's viral load to increase this slowly? He's been off meds since 2018.

I really don't know an answer to this but I do have another comment. Your friend should also consider their cd4 count. Low cd4s give HIV very little to work with (some people who have died from AIDS/HIV, die with very low or no viral load. When the cd4 count is near zero there's not much for HIV to replicate with. ) However, a large cd4 count would give HIV an abundance to work with when the latent HIV starts replicating again.