Another blip?

[Kalel]

2 months ago I had a blip and my VL showed 64c/ml.
I didn't get worried until this week where my exams returned again VL 47c/ml. 

I know it's a very low VL, but I see no reason why I'm not able to get UD again.
I pratically never missed a dose in 3 years! And nothing changed in the last 4 months, really worried about drug resistence.


Should I get worried about it?
When I started, I changed Efavirenz for Ritonavir after 14 months not getting undetectable, and now this...  I really don't want to change meds again...
Worried about not having many options on new meds..


So now 'm taking Lamivudina + tenofovir + atazanavir + ritonavir.
Also, any tips on what could I do to increase the meds absorption?
Take it with/without food, more water...?

[Ptrk3]

You have nothing to worry about.  A Viral Load of 47 would have been considered "undetectable" in the not very distant past.  Testing today has become so sensitive that lower and lower Viral Loads can be measured.

I would expect that your medical providers are unconcerned, so you should be, too.

Just keep with your medication regimen and continue to live your life.

[Mightysure]

If your doctor isn't concerned, I wouldn't be.  As someone has already pointed out, less sensitive tests that were previously used would've considered you UD. There may be a slight resistance issue, but it could be that after the blip, you're taking some time to get back to UD.

I know it's stressful, but it's kind of the catch 22 of technological advancements. 

[leatherman]

A Viral Load of 47 would have been considered "undetectable" in the not very distant past.

this is one of those times when I love jumping in and pointing out that <500 was considered undetectable within just the last 10 yrs   

[Kalel]

Thanks guys, I understand some time ago <200 was UD.

Just worried cause I have a history of resistance, even though being so adherent to the treatment, no drugs, no alcohol... which makes me more nervous.
Keep wondering what am I doing wrong 

[Jim Allen]

Hi

Look if you are adherent to the meds than you are doing nothing wrong and you have only had 1 minor blip of above 50 copies and the follwing VL test it was below 50 again so seems well under controle and no reason to worry at all.

It simply was a blip and it can happen nothing to worry about at all, now it might be diffrent if you kept having blips in the 200's but this was a once off in the 60's range ...

Your doctor is also keeping track of this and you need to also trust them that they know what they are doing 

Take it easy, take your meds and don't stress it.

Jim

https://www.poz.com/article/viral-blips-raise-risk-hiv-treatment-failure

[CaveyUK]

this is one of those times when I love jumping in and pointing out that <500 was considered undetectable within just the last 10 yrs   

yup, this is certainly a case for me to wheel out the 'micro-blip' term

[Kalel]

Thanks you guys!

..So according to my doctor I should wait until february for new exams, and if I can keep it <100 it's all ok.
If not, will change to a new treatment that's comming to Brazil, Dolutegravir (DTG).

[CaveyUK]

Thanks you guys!

..So according to my doctor I should wait until february for new exams, and if I can keep it <100 it's all ok.
If not, will change to a new treatment that's comming to Brazil, Dolutegravir (DTG).

If you get the opportunity of switching onto DTG when it is available I would grab it, personally speaking. It's a very modern Integrase Inhibitor that doesn't require boosting (so has few drug interactions), is tolerated very well and doesn't come with some of the potential side effects of some other treatments.

[rjoh]

Ok fellas (and fellanistas too), here's my current situation:

I've been on Atripla for since 2011, originally my numbers were VL around 200,000 and CD4s around 190. After about a year and a half (maybe 2), I finally became UD and the CD4s in the 500-600 range. They have remained close since 2013.

A year ago, the VL bumped to 95, my ID dr. and I discussed blip vs change meds and wanted to see the next results. Then 6 mo. ago the VL dropped to 60, last week's draw showed the VL up to 175. My ID czar has called me to visit again in a month for more tests......my "numbers" are still "good" (according to the nurse who called as my CD4s remain in 500-600 range, percentage is stable).

I'm not near a panic stage at all (thanks to you guys and your advice to others), but this last VL 175 does have me with a "smidgen" of concern. I realize the VL numbers are low, but not having that actual UD bothers me a bit.

Could a change of meds be in order?

[CaveyUK]

Probably not. Yet anyway, from a medical standpoint. The importance thing is 'trends', and you had a VL reduction followed by an increase, so there isn't a trend just yet.

On the flip-side, since Atripla was the go-to drug, there have been some fine drug regimens released - and some of the Integrase Inhibitor class are well known to help ratchet down the Viral Load, so it may be worth discussing with your doctor if those sort of options are open to you.

You also don't say, but hint that your VL is being measured every six-months. I may have read that wrong, but if so I would push for more regular VL counts to be taken, to establish if there is a trend and monitor any progress (with current or new regimen).

It took you quite a while to get UD, so I wouldn't be alarmed at a bit of movement when the VL is so very low - plus your other numbers are great, but it's worth getting to the bottom of, so it's one less thing on your mind if nothing else.

[rjoh]

Yeah, I was going to my ID specialist every 6 months. I have to go again the first week of February for another draw. We'll see!!