Undetectable?

[Blond37]

is there such a thing as Undetectable.. or is it just that we dont have test to go that low yet?

some of you may remember my post about usually being 45-48 VL and this time it went to up to 55.. so i had to go to an anesesthesiologist (unrelated) and yea i know anes isnt ID.. etc but she looks at the 55 and says "have you ever been Undetectable.?"

so i gave her the song and dance about it not even being a blip and yada yada and test being better and therefore able to measure less VL..

just wanted this groups thoughts?

[Matty the Damned]

Yes, Viginia there really is such a thing as undetectable.

It just means that the VL test cannot detect virus circulating in your peripheral plasma component -- ie the blood that circulates through your arms and legs.

As tests become more sensitive, the undetectable limit drops. I think it is currently around 40 copies per cubic ml. It certainly is in Australia.

Interestingly, the VL tests I have report "detectable but <40 copies" and "undetectable" which, my doctor assures me, are two different things.

It may be different where you live.

MtD

[Blond37]

Yes, Viginia there really is such a thing as undetectable.

It just means that the VL test cannot detect virus circulating in your peripheral plasma component -- ie the blood that circulates through your arms and legs.

As tests become more sensitive, the undetectable limit drops. I think it is currently around 40 copies per cubic ml. It certainly is in Australia.

Interestingly, the VL tests I have report "detectable but <40 copies" and "undetectable" which, my doctor assures me, are two different things.

It may be different where you live.

MtD

i think u misunderstood or i didnt ask the question right.. is there as far as we know anyone alive and poz with a 0 (zero) VL?

[Matty the Damned]

i think u misunderstood or i didnt ask the question right.. is there as far as we know anyone alive and poz with a 0 (zero) VL?

Probably I misunderstood.

I do not know the answer to that question. Perhaps the famous "Berlin patient"?

MtD

[eric48]

is there as far as we know anyone alive and poz with a 0 (zero) VL?

Hi,

referring to this,

http://www.iasusa.org/pub/topics/2010/issue3/104.pdf

in research labs they have procedure that enables them to go as low as 1 copy/mL, and, in fact the article seems to lead the reader to think that a fair number of people, being UD for a while are indeed at or below 1

I discussed this with my doc who commented that nonetheless, some people seem to linger around 25 and they do not know why.

but that do not seem a source of concern.

Hope this helps with your question.

side note:

One of the reason for the remaining VL is that 'suppression' means that the replication of the virus (after it has penetrated the cell) is jammed and triggers cell suicide. Jammed does not mean that the very first attempt of the virus to replicate will be unsucessfull, so depending at with stage of virus replication your meds operate they either kill the cell right away or after a bit of replication (inside the cell), there fore a bit of background 'noise' ... May be...

Eric

[buginme2]

Good question!

That article does infer there is such a thing as a zero vl but most tests used in the US test for <40.  I dont know if its clinically significant. Anyone?

[Rev. Moon]

Good question!

That article does infer there is such a thing as a zero vl but most tests used in the US test for <40.  I dont know if its clinically significant. Anyone?

The short answer to that question is NO.  

A viral load of 20 or 48 (the previous threshold for UD --which is still being used by some labs depending probably on geography and resources) presents virtually no difference to your body.  I have discussed this recently with my ID doctor and a couple of months ago with a couple of professors at my university.  

What could be significant when it comes to this info is precisely the lack of clinical significance.  Kinda goes back to the answers we have sometimes given to those who experience a minor increase in their VL; as long as it isn't a large number of copies it represents no danger to your body.

[buginme2]

I believe the rev moon is correct. Low level viremia below 50 copies is insignificant as it does not indicate active replication and is most likely due to reservoirs of virus becoming active.  According to the article that was posted earlier.  Good article. Thanks.

[eric48]

Hi,

In drawing the picture for future research in HIV one our local experts had listed a number of 'current issues'

one of then is: is it worth to spend $$$$ in developping /buying equipments that will go below 50 as, the way I understood it, instrument manufacturers seem confident that they can release newer instruments going down to 5.

If we spend more, do we get more benefits ?

I think lowering the UD limit from 500 (which was the lowest attainable limit a few years back) down to 50 (or currently 20-40 on some machines) was a real improvement. I do not think that this is a matter of debate anymore.

Apparently trying to go down to 5 is a matter of debate.

In effect, if somebody has a per sitant VL below 500 , but above 50, (say 400, for the sake of example), then it shows that replication still occurs and statistically mutation MAY occur (hence resistance, etc)

Is it the same one decade below? if somebody is persistently below 50 but above 5 (say 40, for the sake of example), will replication be high enough to allow mutations ? can a switch help improve the situation ?
and what is the cause for this situation (some individuals remaining at 25, as my doc mentioned, but Dr Siliciano's paper does not suggest).

If the meds are efficient, the virus replication is suppressed.

There is no such thing as super super suppressed, or super suppressed, suppressed is suppressed: suppressed is suppressed enough.

Once the the nail has fully entered the board, there is not super nailing or super super nailing. nailing is good enough.

That is the take home message from that article.

One of the reservations I would have, though, is that this article aims at studying a process and for this, observation on a small number of patients is good enough.

Extending the understanding of this article beyond its original scope is, IMHO, still a stretch.

While it kinds of suggests that, once UD, the virus has NO chance to mutate, it does so on a limited number of cases.

Considering that EVERYONE, who is below 50, remains below 50 and is adherent is SAFE from mutation (hence resistance), is a (common) way to understand Dr Siliciano's work.

This is most likely the case... Yet, I would prefer to have a larger number of individuals studied before we can carve into stone.

But as of today, this is all what we have...

I do not know how you feel about it, but, as far as I am concerned, it helps me enjoy good and deep sleep

(which is what I am going to do right now)

Going to sleep is now as easy as counting sheeps (or CD4...), I just count down my VL:

50, 49, 48, 47, 46, 45, ------------ 44, -----------------------------------

Have sweet dreams

Eric