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Main Forums => I Just Tested Poz => Topic started by: Matths on November 07, 2019, 12:06:25 pm

Title: blips
Post by: Matths on November 07, 2019, 12:06:25 pm
Hello,

I was diagnosed in march 2019, started on Triumeq and switched to Dovato about 6 months ago when it became available. Responded to Triumeq and became U within 4 weeks, and remained that way wit Dovato. However, I developed a blip VL 37 after about 3 months on Dovato (maybe triggered by labial Herpes?), then U 4 weeks later, and now 2 months later another blip with VL 67. Are blips in general more likely in the early phase of treatment (during the 1st year) relative to more stable treatment. I have 100% compliance with medication, so that can be ruled out. Thanks for sharing your experience with this topic.
Title: Re: blips
Post by: Jim Allen on November 07, 2019, 12:16:43 pm
Hiya,

Welcome to the forum, sorry to hear about the diagnosis but glad that you have started treatment.

How are you doing generally?

Regarding the blip, what did your doc say out of interest? Anyhow overall to me seems your meds are working and you're doing well for the first year,  The VL trend is below 50 copies despite the switch with only one "Micro" blip above 50 copies of 67, so the medication is working in that regards as designed.

The first year some tiny blips would not be uncommon and you are only a few months in, neither would it be uncommon to micro blip during a switch. It would be more alarming if it was a trend into 100's or 1000's

This 3 pager is worth reading through as it gives some great real-life context to blipping. 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

Best, Jim

https://www.poz.com/basics/hiv-basics/starting-hiv-treatment
http://i-base.info/cd4-count/

Low-level blips & 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/

4289 individuals - very low level viraemia (20-49 copies/ml) was not associated with subsequent virological failure when compared to persistent suppression below 20 copies/ml

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3308904/

3550 participants blips of 500999 copies/mL were associated with virologic rebound, whereas blips of 50499 were not.

In addition, there is the theory that no resistance and good adherence micro blip are due to a release from the viral reservoir perhaps including defective copies being released.

Defective copies - 90℅ or more of HIV in reservoirs are rejects
https://www.sciencedaily.com/releases/2016/08/160808150523.htm

Viral blips (50 - 500 copies) during suppressive antiretroviral treatment are associated with high baseline HIV-1 RNA levels
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915053/

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
 
Title: Re: blips
Post by: Matths on November 07, 2019, 12:22:22 pm
Hi, thank you for replying. This is helpful. Overall, I am doing very well. No side effects, no symptoms. Started treatment with a VL 47,000. That is why I am concerned about these blips.
Title: Re: blips
Post by: Matths on November 07, 2019, 12:24:34 pm
The doctor is not concerned. Met him a couple of days ago and he attributed it to the herpes (1st blip), and a minor cold the 2nd. He did not even consider switching treatment, and since I have no side effects I would prefer staying on Dovato also given that the clinical trial data are very convincing.
Title: Re: blips
Post by: Jim Allen on November 07, 2019, 12:28:43 pm
Perfect, sounds like you have a good doctor, stick with them.

You only had 1 tiny blip above 50 copies and that is not an indication of any treatment issues so no reason to worry or to think about switching.  Relax  :)

If I stressed every time my VL was fully suppressed between 0-50 or about single blips over 50 I would have died years ago from a heart attack.  :)

Quote
Overall, I am doing very well.

Glad to hear it and stick around.
Title: Re: blips
Post by: Matths on December 05, 2019, 09:09:17 am
I will bc this forum is important in moving on with life.

Btw, the control VL was NOT DETECTED <20.
Title: Re: blips
Post by: Jim Allen on December 05, 2019, 02:18:27 pm
Glad to hear all is well.  :)