15 months on Atripla and still not got an undetectable Viral Load.

[Matt Butler]

My wife has been on Stocrin (Efavirenz) & Truvada since August last year and has still not achieved an undetectable viral load. Indeed this month’s result showed an increased VL to 175.

On the last visit our ID Doctor said that it would be futile to have a resistance test unless her VL is over 200 as anything less would be too difficult to measure. I imagine that my wife will be asked to get her VL retested in 1 – 3 months.

We will be seeing our ID Doctor this weekend but just wondered in advance if there were any suggestions we could bring to the table as it seems to be an inordinately long time to still not be undetectable.

Her previous labs are below:
 
Feb 2006 Tested positive
18-Jan-11   387   32%   58,600            
14-May-11   366  30%   153,600            
04-July-11   333   27%   321,000            
04-Aug-11   272   25%   448,000            
07-Aug-11   Started Stocrin (Efavirenz) & Truvada           
30-Aug-11   346   31%   3,200            
16-Nov-11   392   32%   133            
17-Apr-12   701   38%    65            
23-July-12                     50            
17-Oct-12   820   38%   175            
            

[Ac75088]

Is she taking her medicine every day? Has she missed any doses for a period of time? That's the only thing I could think of as to why VL is not yet UD and there's an increase.

[Matt Butler]

^ Ac75088, it has me stumped too... She has great adherence to her meds and has not missed any doses and never been more than a couple of hours late on a few occasions. I am hoping the increase to 175 may just be a blip. Nevertheless it is rather disconcerting that nearly 15 months later she is still not undetectable.

[james3000]

Hi Matt,

You may want to ask the ID Dr about therapeutic drug monitoring, maybe your wife is having problems absorbing the Meds ? This test looks at the level of HIV meds in the body after 12 hours.

[mecch]

Looks to me that she is effectively undetectable since Nov 11. Maybe thats her body's version of undetectable.  I dunno obviously Im not an expert. It seems a few people are always flitting about in those very low low viral loads. Ask the doctor if he/she thinks your wife is on successful treatment, or not, and if not, what to do about it.

[thunter34]

By some testing standards, below 80 IS undetectable, so she already kind of has reached that level on two separate occasions.  In any case, while it's not as fast as you'd like, it's certainly not unheard of for it to take that long.  175 is still so low that I personally wouldn't be all that worked up about it.

Her percentages are actually up, and that's a good thing - I'd value that more than worrying between 175 and "UD".

[Matt Butler]

Thanks for all of your responses above. It has certainly helped me marshal my thoughts prior to our Dr.’s appointment.

James, I will mention TDM as my wife takes her meds about 10.30 pm and any lab tests are done the next morning about 12 hours later.

Meech, I will indeed ask our ID Dr. if is this considered successful treatment to date. (As well as going forward if her VL remains at these low levels in the future too).

Thunter, like you say her percentages have come up and that is very encouraging.

[harleymc]

hi Matt,

Your wife sounds like she is doing quite nicely. It is lovely to see your care and concern for her wellbeing.

The difference between her results and 'undetectable' is really very minor. The difference between her pretreatment viral levels and the vl on treatments is in the several hundredfold + range which is great/awesome/excellent/fantabulous.

It can take years for all the non-blood stream reservoirs of HIV to 'flush out'. There will be small amounts of HIV being released into the blood (especially when pretreatment VL was high) but it doesn't necessarily mean that the HIV is replicating in the blood stream.

Your MD is right, a resistance test at these low levels would not show any results. Your MD may or may not recommend a change in regime, but remember, quality of life is as important as minor variations in blood test counts. A well tolerated/ minimal side effects regime is  something to treasure.

I hope your MD can put you into a nicer head space about these test results. Good luck to you both.