Blips on Odefsey

[SoSadTooBad]

Hey all - positive since 2006 with 100% adherence to meds and no other health conditions.  Switched from Atripla to Odefsey about two years ago - great switch to get away from Sustive side effects. Undetectable on Atripla for the entire time with 1 blip years ago. 

First year on Odefsey I was undetectable in both sets of blood work.  In June, I had a detectable VL of 159 and just repeated blood work this week, again detectable at 139.  I know these are really low, but this is pretty new to me.  First question was about adherence and then the thinking was just an odd blip - now two in a row one month apart...   Any thoughts?

[daveR]

Are you taking it with food? Minimum 400 calories and 12 g of fat to get full absorption of the Rilpirivine. Quite important.

[SoSadTooBad]

Hey all - hope you are doing well.  I have been having an issue for about the past 18 months - after 14 years of being undetectable, I am not seeing VL of 50 / 100 / 150 / 50 on Odefsey.  I was originally on Atripla - switched to Odefsey about 4 years ago - was undetectable until about 18 months ago.  Now, detectible every time, but with a very low VL.  All other labs very good - so no immediate health concerns.

What would you do?  Doctor has been saying not to worry - and that at that VL, there isn't much to look for in terms of resistance, etc.  But the more I read, the more I get concerned about it.   Any thoughts? 

[Jim Allen]

I can see why the doctor isn't worried, but also understand why you may feel concerned.

Minor blips can happen for various reasons, including detecting the low-level release of virus from existing reservoirs and defective copies.

Treatment wise, it's still generally accepted anything under 50 copies is fully suppressed.

Now if these results were mine I would not be worried at all and, I have had had blips before, but if you are stressing or the concern is keeping you awake at night, then perhaps talk about switching treatment for peace of mind.

Take it easy.

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

[SoSadTooBad]

Yes, daveR, taking with food every time.  Thanks, Jim, sometimes it worries me, other times, not so much, just not sure how hard to press the doctor on it. 

[SoSadTooBad]

Just to update you guys, I had additional blood work, and still detectable (159vl)

Doctor said the vl is too low to do any sort of resistance testing, but based on my history of not being resistant to anything, she switched me to Biktarvy.  Going for labs in about 3 weeks...  Wish me luck. 

[Expat1]

Rilpivirine need an acid environment.  That is compromised if you are taking calcium supplements at the same time (plus or minus 4 hours), or Proton Pump Inhibitors like omeprazole, or H2 inhibitors like Pepcid.   Tums and Rolaids are Calcuim.

Also I had a few blips on my complera but realized that it might be because I always take it in the morning. When I got my blood tests.  I fasted so hadnt taken it those mornings, and instead takeing it at lunchtime.  TTat meant that I hadnt taken a dose for over 36 or 27 hours (because of the food requirement). So I started taking it on those days with a meal at midnight to 2am.   Then labwork at in morning. 

No blips past year.

[SoSadTooBad]

Thanks, expat.  In my case, I am really thinking it is a lab issue.  ( I know, not likely, but I requested a VL test from Labcorp instead of their in-house lab and it was undetectable. )  So - detectable for almost a year using in house lab - even detectable 4 weeks after Biktarvy.  First lab test using Labcorp, and back to undetectable.  Not sure what to make of it, but happy with the result and plan to stick with Labcorp for a while...