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Author Topic: Constant blips  (Read 4879 times)

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Offline Kalel

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Constant blips
« on: July 10, 2017, 01:08:49 pm »
So.. here again.
I just have done my exams (once every 6 month) and again I had a Blip.

My history actually is:
October/2016 BLIP 64c/ml.
December/2016 BLIP 47c/ml. 
July/2017 BLIP 53 c/ml.

I know it's a very low VL and bellow 200 should be considered "undetectable".
But isn't this kind of constant? Or can I consider this a normal occurrence?
I'm not aware on how many blips people usually get.

My main concern is if I'm in risk of a Treatment Failure.
I'm taking Lamivudina + tenofovir + atazanavir + ritonavir.
CD4: 1077



Offline Ptrk3

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Re: Constant blips
« Reply #1 on: July 10, 2017, 02:55:27 pm »
Relax, you are most certainly not in treatment failure.  No, viral load is not a constant.  There can be very minor "blips" such as what you may be experiencing.

Your CD4's are amazingly strong.

You are doing fine.  Keep up the great work!
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Offline Mightysure

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Re: Constant blips
« Reply #2 on: July 12, 2017, 11:20:18 am »
Maybe I'm just hung up on terms, but I thought I blip was when someone who was UD has a low but detectable VL. Have you ever been UD? If not, it may be your body and the meds. Your cd4 is excellent so your body may not be metabolizing the meds  properly, or (I really hope not) there may be slight resistance? Just thinking of possibilities.
If your doctor isn't concerned at this point, I wouldn't be. Some people for whatever reason stay detectable but low.

Offline AusShep

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Re: Constant blips
« Reply #3 on: August 05, 2017, 03:39:25 am »
I wouldn't consider consistent low viral load measurements blips. 

Have you had a resistance test done? 

I have a weird resistance profile and lots of mutations and have had occasional blips, every 2-3 years for a decade.  I just had a reading of 30 a few months ago.  Prior to that I had assumed my switch to Tivicay had put an end to my blips, but after a few years, seems like over 3, but I didn't check, blip...

I don't think it's a major concern, but it might be worthwhile to see if there is a more effective med choice available to you. I believe the new resistance tests can be done at low viral levels like yours.

I'm with ptrk3 envious of your CD4 count.  I'll take 20 of your VL if it comes with 200 CD4's. 

Offline awakening

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Re: Constant blips
« Reply #4 on: August 10, 2017, 10:11:18 pm »
@Kalel, as you can see from my profile I've had a couple of blips this year as well. At least there were a couple of UD between, but every time it happens my ID doc wants me to retest in a month to make sure it's not the beginning of a failure. That's the protocol. Blips under 200 are generally not considered a failure, of course it also depends on the pattern over time. Some people seem to go years before they get their little blip, so either we are getting ours out of the way early or something is going on with the meds or the way our body deals with the HIV. It does leave me wondering, have I been "blipping" for the past three months or have I been mostly UD for the past three months? We only capture a single moment in time every 3-6 months.

There is interesting research that has been done on blips and laboratory testing. If you took your same blood sample to 5 different labs you would get 5 slightly different results.

Quote
One study measured viral load in blood samples from ten patients every three days for four months in two separate laboratories. Nine patients had one or more viral load blips, but only one of the 18 total blips was detected by both laboratories at the same time.

So had it gone to one lab it may have qualified as UD, another lab as a 'blip':

http://www.aidsmap.com/Viral-blips/page/1729801

My doctor agrees that we are somewhat victims of over-testing. 15 years ago the meds weren't as good and they needed to keep a closer eye on levels than is probably necessary now. As has been pointed out, the extra testing can be good if it helps find something early, and sometimes problematic if it makes the subject unnecessarily stressed.
« Last Edit: August 10, 2017, 10:15:27 pm by awakening »
~~~~
[month/date/year]
3/1/16: Tested neg (Oral swab)
6/17/16: Diagnosed poz (finger prick), confirmed w/Multispot assay
6/17/16: VL 22,900, CD4 - 524 cells/uL (30%)
7/2/16: Started Triumeq (DTG+ABC+3TC)
8/1/16: VL 30
10/4/16: VL <20, CD4 - 630 (31%)
1/4/17: VL 90
2/7/17: Undetected
4/17/17: Undetected, CD4 - 695 (33%)
7/20/17: VL 75
8/21/17: VL <20
11/27/17: VL<20
3/26/18: VL<20, CD4 - 701 (36%)
5/14/18: Switch to Juluca (DTG+RPV)
6/11/18: VL<20
7/25/18: Undetected, CD4 - 632 (38%)
1/22/19: VL<20

Offline Jim Allen

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Re: Constant blips
« Reply #5 on: August 11, 2017, 06:19:24 am »
Hi OP

Like any labs its single snapshot moments and if you took measurements over a few days you would have some variance even at the same lab.

If you are adherent to the meds than you are doing nothing wrong and you have only had 1 minor really above 50 copies so it seems well under controle and no reason to worry at all.

From a treatment point of view, 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.

I included a link on blips, read it but don't read too much into it and keep the above  in mind that you only clinically speaking had 1 minor minor blip, so nothing to worry about and your doc is tracking this.

Jim

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

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Re: Constant blips
« Reply #6 on: August 11, 2017, 06:50:57 am »
Here's another study on the variabilty of viral load testing results:

http://www.thebodypro.com/content/78684/if-at-first-an-hiv-viral-load-blips-test-test-the-.html

Quote
...the range of values for each sample was wide enough that a care provider might take a different clinical approach depending on which result was received. For instance, a sample that originally yielded a result of 36 copies/mL, below the limit of detection of commonly used assays, was found to have an average retest result of 61 copies/mL, with individual values ranging from less than 20 copies/mL to over 100 copies/mL. Two-thirds of the retest results in that case were over 50 copies/mL.
~~~~
[month/date/year]
3/1/16: Tested neg (Oral swab)
6/17/16: Diagnosed poz (finger prick), confirmed w/Multispot assay
6/17/16: VL 22,900, CD4 - 524 cells/uL (30%)
7/2/16: Started Triumeq (DTG+ABC+3TC)
8/1/16: VL 30
10/4/16: VL <20, CD4 - 630 (31%)
1/4/17: VL 90
2/7/17: Undetected
4/17/17: Undetected, CD4 - 695 (33%)
7/20/17: VL 75
8/21/17: VL <20
11/27/17: VL<20
3/26/18: VL<20, CD4 - 701 (36%)
5/14/18: Switch to Juluca (DTG+RPV)
6/11/18: VL<20
7/25/18: Undetected, CD4 - 632 (38%)
1/22/19: VL<20

Offline Jim Allen

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Re: Constant blips
« Reply #7 on: August 11, 2017, 08:00:11 am »
I think the conclusions from that last one are essentially the same as now or at least I am not seeing a difference. Test results vary and hence trends and retests are key. 

1 lab low level blip result is no reason to change treatment or worry as a patient. If a trend occurs or the need clinically arises retest and consider testing for resistance.

Jim 
« Last Edit: August 11, 2017, 08:18:02 am by JimDublin »
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Offline Kalel

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Re: Constant blips
« Reply #8 on: September 18, 2017, 09:31:28 pm »
Hi again, sorry insisting on this, but I'm really getting sad about it.
Today i've returned to my doctor with new exams... and

Again a Viral Load of 64c/ml.

So now, my doctor decided to change my regimen, which makes me very very nervous.
I will change from Norvir + Tenofovir & Lamivudina + Advantaz
to Norvir +Tenofovir & Lamivudina + Darunavir (x2)

Accordind to him this is a stronger regimen, and should end my VL, and stop the risk of getting a resistence.

But it's my second time changing regimen since I can't keep my VL on zero. At the beggining I started with Tenofovir + Lamivudina + Efavirenz.


I'm wondering if I should ask to wait until my viral load is 1000 so we can try a resistance test. Or should I trust him and change again?


In 4 years I've missed at most 4 doses, so I've very responsable about my condition.
I'm really confused on what to to, and very sad that this is not working for me.

He also asked me to drink more water and stop taking whey protein cause my liver exams are starting to show bad results...


I really was not expecting that, I remember feeling like this when I got my positive results, and I always believed that would be ok if I was very strict to my regimen.  :'(


October/2016 BLIP 64c/ml.
December/2016 BLIP 47c/ml. 
July/2017 BLIP 53 c/ml.
September/2017 BLIP 64c/ml.

**Sorry the bad english
« Last Edit: September 18, 2017, 09:33:49 pm by Kalel »

Offline Kalel

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Re: Constant blips
« Reply #9 on: September 18, 2017, 09:42:02 pm »
@Mightysure, yeah, It took me 1 year and 3 months to get first UD, and I had to change my regimen. After that I've being UD for 2 years, and got these BLIPS on my last year.

@Aushep, I can't do a resistance test with such a low VL, I need to wait until it's on 1000 at least.

So I wonder if I should insist on this regimen or trust in my doctor and upgrade my regimen with Darunavir before a resistance.
« Last Edit: September 18, 2017, 09:44:31 pm by Kalel »

Offline Mightysure

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Re: Constant blips
« Reply #10 on: September 28, 2017, 02:34:47 pm »
I can understand your frustration and concern.
Unless I overlooked it, it doesn't seem like an integrate inhibitor has been tried. I don't know what country you live in, and you don't have to disclose that, but maybe suggest a regimine consisting of either: raltegravir, elvetigravir, or dolutegravir. They're one of the newest class of meds and have a low resistance profile.

But you're hovering around a safe number, so it may not be resistance. If it was resistance, your VL would likely keep increasing. Have you ever had resistance testing done?

Don't feel bad for being concerned about your health.  That's why we're here.

Offline Kalel

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Re: Constant blips
« Reply #11 on: October 15, 2017, 08:46:48 am »
Thanks Mightsure, I live in Brazil.
My doctor wanted to use Dolutegravir, but it’s taking too long to be free distributed here, maybe soon 2018. He doesn’t want to risk a resistance, and I would have to wait until VL 1000 to do a resistance test, so I’ve never done it.

 


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