Early blip a concern?

[texashouston1]

Hi everyone,

I have been lucky to find this forum. Honestly reading everyone's experience and learning we all go over the same issues and questions gives me some piece of mind.

One of those issues is that I started my treatment early December 2020, with a VL baseline of 400,000. VL went down to 500 two weeks after treatment, and after my first covid vaccine (Moderna) in April the test was >20 (UD).

However, doctor asked me to have labs again after two weeks from second covid vaccine shot, and VL came up as 50. Is that considered a blip, even so early after initiating treatment?

Thanks!

[Jim Allen]

Hiya,

Glad to hear that you have started treatment and the labs are doing well.
How are you otherwise feeling/doing?

Regarding the 50 copies, it's not even a blip yet and you are in the first 6 months of treatment. I presume you were also newly diagnosed when you started treatment back in Dec?

Now, minor blips can happen for various reasons. However, I would not even think twice about this had it been my own results unless it was a continuously increasing trend over time and in the high hundreds to low thousands.

There is also strong evidence that as ART takes care of the active viral load some transient blips are nothing more than the detection of the low-level release of virus from existing reservoirs, including defective copies and that those who blip more often tend to have larger HIV reservoirs and hence it's not a concern for with the treatment etc.

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

Treatment wise, it's still generally accepted anything under 50 copies is fully suppressed (UD) so keep taking your meds correctly and this micro blip should be gone the next time you test.

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

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/

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

[texashouston1]

Thanks Jim!

And yes, I was newly diagnosed on November 24th 2020.

I am feeling really good so far. It felt really good seeing my first UD result mid April but this VL 50 result made me a bit anxious. I guess I am just being inpatient 

Thanks again

[Almost2late]

I also found this link on blips..
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915053/#:~:text=Viral%20blips%20are%20defined%20as,time%20period%20of%20six%20weeks.

I was diagnosed in 2014 and it took me over 6 months for my viral load to go from 230,000 to 110.
For the first 3 years I would jump from an UD viral load to something under 200 while on triumeq, I felt like a yo-yo. But since 2017, I have not seen a blip and still on the same medication.

Not insinuating that this will happen to you, I had the virus for over 10 years before the aids diagnosis.. just saying you are doing well and one blip, especially in the beginning of treatment, is nothing to over worry about.

Your doctor is keeping an eye on your viral load "just in case", but if you're adherent to your treatment chances are that the blip is nothing but a blip.

It's like turning off a water faucet.. it drips a little bit before it totally dries up 
 

[Mightysure]

Hi Texas,

It isn't technically a blip. Back in 2014 when I was diagnosed, 50 was the cut off for UD.

Not sure why your doctor wanted labs so soon after your vaccine shot, but you were in the window when your body is still making antibodies for Covid.

So it is probably like Jim said, just your immune system shedding some of your reservoir and the test is picking on that.

I wouldn't be too concerned at this point.

[texashouston1]

Thank you everyone.

[leatherman]

I felt like a yo-yo

this is a really interesting comment. Many people (if not most) seem to think that our body functions work in straight-line functions. In our situation that would be thinking that the viral load goes straight down to zero, with no blips back up; or CD4s going straight up from 200 to 1000 with no dips. That is not how bodies work. All day long, your blood pressure, temperature, cd4 and 1000s of other functions jump around. You could take 20 tests in a day and get 20 answers.

Taking meds don't even work in a straight-line function. An antibiotic doesn't immediately wipe out all the bacteria. It can take a week or more of antibiotics to completely do the job. ARVs don't immediately kill off HIV. ARVs simply stop viral replication of some of the free-floating virus. As time goes by, there is less and less virus, and so the med efficiency actually gets better as there are more meds in your body and less HIV.


a few other notes of interest to mention:
successful HIV treatment as defined in scientific studies as a viral load of <200. The word "undetectable" is not an accurate medical term. While there is test an expensive test that can accurately count down to a VL of 2, the average test these days counts to 20, labeling that as "undetectable" or "not detected". A micro-blip of cd4 count less than 200 means absolutely nothing to your health or effectiveness of the meds.

a single test with any size blip (25 to 5 million), especially when someone has remained adherent, means little by itself. Since our body functions are so variable, some results (like cd4 and VL) need to be viewed as the result of at least 3 tests over at least 3 months time. For example, viral load counts of UD, 250, UD graph out basically as a straight line of no change. Another example, a VL of 250k, 10k, 20k, 200, UD graphs out to a downward trend, even with that blip of 10 to 20k.

Unfortunately, HIV is never completely eradicated by the meds, and some latent HIV remains in reservoirs in our bodies. (that's why we have to keep taking meds for our lifetime) At any time, some of this HIV could become active and register if you are tested at that moment. this could easily result in a small "blip" that doesn't mean med failure.

Back in 2014 when I was diagnosed, 50 was the cut off for UD.

in 1992 (when I was diagnosed) there wasn't a viral load test. By 1996 (when I was first hospitalized with AIDS and PCP), a test had been developed that could count only as low at 10k. by 1998 (when I was hospitalized a second time with PCP), a viral load of 500 or less was considered successful treatment.