Husband Started Treatment in October - Confused About Lab Results

[PatrickDaniel052]

Hi All-
I see a lot of posts about lab result questions, so I apologize in advance if I am duplicating a question. My husband was diagnosed with HIV in September, 3 months after we married. He began treatment in October and is currently taking Biktarvy.
His first round of results were very positive and he was told he was undetectable. He went back for his last results and he e-mailed me in a panic with the results today. His HIV RNA copies are now at a 26. He is saying that he thinks they need to be below 20. I have done my own research and believe that this is actually a very low number. English is not his first language, so I often have to research and translate for him. The number of copies on this result is slightly higher than his last test a few months ago. I have read that there can be "blips" due to various reasons, but that follow up is still recommended. Is this something other people have experienced? Is there a good resource out there for novices that explains how to interpret these results. Thank you so much for any feedback you may have. Love and peace to each of you.

[MarkintheDark]

Welcome PatrickDaniel.  Others will undoubtedly chime in...and I'm only speaking from my experience.  I'm not a physician.

imo, no worries at all on the 26 copies.  Yeah, they can vary slightly...just like you'll see variations on the CD4 absolutes and percentages.  Depending on the test's sensitivity the range of UD can be <20-50 copies.  I'll add that more consistent results will be achieved if the draws are done at the same time of day.

Since this is a relatively new dx for him, he (and you) are still in an adjustment period.  Most of the folks here will tell you that, early on, they obsessed over every small change in numbers from the alphabet soup of tests.  You can tell the husband that's perfectly normal - heck, this is still new! - and the feeling will subside.  fwiw, many have found some kind of therapeutic counseling very useful in the early months of treatment, say, through an AIDS service organization.

Meanwhile, y'all go out and do something nice for yourselves.  He's responding well and doin' good.

[Jim Allen]

Indeed.

Welcome to the forum OP, sorry to hear about the diagnosis.

How are you coping & feeling? How is your partner feeling?

He is saying that he thinks they need to be below 20. I have done my own research and believe that this is actually a very low number.

To be honest we have tones of members who have the odd stress moment over micro blips etc etc when simply no stress or focus is required as its actually grand.
Perfectly fine even . Great recent example https://forums.poz.com/index.php?topic=71709.msg

26 copies = UD .

See you could even get tests normally used in research that go as low as 1 copy, however that is not the accepted goal. You're husband is UD by all definitions that matter, its just the sensitivity of the test is high. In terms of treatment clinically speaking under 50 is undetectable that is normally spoken the accepted goal of treatment even though lots of labs can be more accurate than that like in your husbands case

Virological failure is mostly seen as a failure to sustain a person's viral load to less than 200 copies, the UD threshold for transmission was set at the higher virological failure threshold, so anything under 200.

I have read that there can be "blips" due to various reasons, but that follow up is still recommended. Is this something other people have experienced?

Blips as in continued being over 50 should be watched but even a once off blip over 50 means nothing. As long as he is taking his meds correctly and consistently he should remain UD and have the levels checked once every 6 months on routine check-ups. 

Jim

http://i-base.info/guides/changing/viral-load-blips

https://www.poz.com/basics/hiv-basics/starting-hiv-treatment

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/

[PatrickDaniel052]

Thank you so much for your kind and thoughtful responses. That is very reassuring and helps me to put things in perspective. I look forward to the day when living with this diagnosis is more of a routine fact of life and not something we stress about as frequently.

We have received very good support from the social work staff and doctors at the infectious disease department that is providing care to my spouse. I have been so impressed with how good they have been to us. Ironically, I have done work in the community as a social worker and previously thought I was more knowledgeable about these things. It's so different when it happens to you. I am familiar with resources in the area that we can contact. I have encouraged my husband to consider attending a support group but he is not ready for that right now. I have seen a counselor on my own and it has helped me to keep things in perspective and maintain some calm.  I think right now we really need to focus on committing to self-care and stress management so that we don't turn a manageable situation into something that feels overwhelming.

Thank you again for your responses. I am bookmarking the resources above and will review these with my husband.

[Jim Allen]

Hiya,

I have seen a counselor on my own and it has helped me to keep things in perspective and maintain some calm.  I think right now we really need to focus on committing to self-care and stress management so that we don't turn a manageable situation into something that feels overwhelming.

I'm glad to hear you are aware of the importance of self-care and stress management. Its really important to look after your own well-being.

Overall I think a HIV diagnosis can be a lot to digest and, it can take time. The peer support you recommend your partner is a really good step, and its something I recommend to newbies as well although as beneficial as I believe it is, it can take time before someone is ready for that.

Take it easy.

Jim

P.S

I am bookmarking the resources above and will review these with my husband.

Yeah. Just don't overdo it on reading it will drive you insane. In short he is UD, his meds are working and that's it the job is done! Now is the focus on getting back to living your lives.

If you really have the need to read something on the topic than prehaps this will give some perspective. Its a 3 pager but its clear & easy to digest

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
 

[PatrickDaniel052]

Thanks so much, Jim. I am so grateful for this feedback and this forum right now.

[Jim Allen]

You're welcome.

We're here whenever you need us.
Best, Jim