Viral load down, Detectable.

[TGun]

So I've been LWHIV for last 4 years,, after starting treatment quickly acheived undetectable levels and saw viral load continuously climb after every blood draw.  Four months ago i saw a dip in viral load and still was undetectable,, ID MD said don't worry about it.  Now i just got back my next quarterly labs 10 days prior to my visit and my viral load has sunk even furthur (833-512) and now im undetectable (+20) . 

is there anyone on here with any first hand experience or knowledge as to what to expect and how to proceed.. i guess im mentally torn up over this and its agonizing to wait till next friday for some qualified answers..  any help is appreciated.

[leatherman]

are you talking about your cd4 count? "Undetectable" (i.e. <20) or a viral load <200 means successful treatment

if you're talking about your cd4 count, then there isn't anything to worry about. the "normal" range of cd4s is anywhere from 400-1200. There is nothing to do to increase cd4s besides staying adherent to meds (so hiv doesn't kill those tcells) along with good exercise, good nutrition, less stress, no smoking, etc.

cd4s can change by 100 pts in a day, so are highly variable between each test.  Also the cd4 count is an absolute quantity number and not a measure of the strength/effectiveness of your immune system. The idea is that more cd4s is better although some people with low cd4s experience little illness while some people are sick with high counts. Unfortunately there is no way to measure the quality of someone's immune system.

For PLWH that just means that the cd4 count means little as long as it's >200 (less than 200 has been shown to make people exceptionally susceptible to having an opportunistic disease). The number to really watch is the VL. If it's in the "undetectable range" then HIV is suppressed and your body is basically running the way it would without HIV.

[TGun]

leatherman,,, thanks for your reply,,, i was actualy talking about both numbers.  CD4 keeps dropping while predictably always increased during every visit, and Viral Load was always undetectable,, but now is detectable.

i go to quest labs, and what is weird on their report is how it reads.. it says "Hiv <20 detected"   and its in a re box,, although usually its a great box and says not detected.  so whats bizzare is that theres no acutual number,,, the way i read it its either more or less than 20.. and also they typing isn't any diffrent, just the color of the box,, its usually green and now its red....so im reading it to be detected <20....i know this may sound confusing,, sorry

[Jim Allen]

So HIV was detected but below the threshold that the test could provide an accurate count. The result you mention means your viral load is still "undetectable" (fully suppressed) in any way that matters so treatment & passing the virus on.

If it was my labs only if the VL unexpectedly reached mid to high hundreds might I raise an eyebrow.

[Jim Allen]

P.s I'll post references after finishing work

EDIT - updated below with a post & links I used for a similar question.

anything under 200 copies is UD in terms of forward transmission. https://forums.poz.com/index.php?topic=71848.0

Minor blips can happen for various reasons, there is strong evidence that as ART takes care of the active viral load some transient blips are nothing more than the detection of the low-level release of virus from existing reservoirs, including defective copies and that those who blip more often tend to have larger HIV reservoirs and hence it's not a concern for with the treatment etc.

See link for "What’s All This Fuss I Hear About Viral “Blips”?

Treatment wise, it's still generally accepted anything under 50 copies is fully suppressed/UD although blips past that are not really a concern either if it's a once-off or remains at a controlled low level.

Blips
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/

What’s All This Fuss I Hear About Viral “Blips”?
https://academic.oup.com/cid/article/70/12/2710/5573119

TaSP U=U
https://forums.poz.com/index.php?topic=71864.0
(*undetectable viral load defined as less than 200 copies/milliliter)

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

[TGun]

thanks so much Jim

[Jim Allen]

No problem.

Updated my post with an answer I provided to a similar question raised, I hope that helps.

For PLWH that just means that the cd4 count means little as long as it's >200 (less than 200 has been shown to make people exceptionally susceptible to having an opportunistic disease). The number to really watch is the VL. If it's in the "undetectable range" then HIV is suppressed and your body is basically running the way it would without HIV.

I fully agreed with Leatherman, the CD4 counts are rather irrelevant. It's not a measurement of overall health and they bounce up and down all the time. Some people have a more stable trend, genetics I suppose plays a role.

My last CD4 counts were 800 - 848 - 1140 - 670 and most recent 610 - Is 1140 better than 600? Should I be worried? Is this because I ate a burger at MD's as a treat or had a late night once? No is the answer to all these things, as long as my viral load is suppressed then the CD4 count once above 200 or 14% is nothing to worry about.

[leatherman]

CD4 keeps dropping while predictably always increased during every visit

since cd4s are so variable, the best way to look at them is by the trend. Look at the numbers of at least 3 tests over at least 6 months. (you could even graph them out) Is the trend up or down or basically no change? that will give you a better idea of what's going on.

You can also check the cd4% (my results come in a test labeled "LYMPHOCYTE SUBSET PANEL"). this is a less variable number. This number represents the percentage of total lymphocytes that are CD4s. Go back through a few results and see if this number is steady or changing. If your cd4 count is lower than you expect, the cd4% can put it into better perspective by telling whether this is an actual change or just a fluctuation.

"Hiv <20 detected"

"undetectable" is such an imprecise word. Until there is a cure, there's always some HIV in your system, either free-floating or stored in reservoirs where it stays latent for the most part. Periodically, this latent HIV will reactivate - and that's why we take meds every day to stop this HIV. Theoretically then you could test one day and have results for "undetected" (which only means that the test which goes to 20, didn't detect at least 20); but the next day you could test and get a "detected" result .... if those latent reservoirs released some HIV. "<20 detected" means that the test, which goes down to 20, measured some HIV but <20. Is that any different really than "<20 undetected"? not really. In both cases the viral load is well under 200 (which is the goal of successful treatment) and if the patient remains adherent to meds, there's nothing to worry about.

[TGun]

jim and leatherman,,

you gents are a godsend.  thank you so much for your time with all of this.  its such a mind fcxk this whole thing can be and unfortunately there is very little to if any community out there to help in these situations.. ive always just felt like im in this on my own over the years.... thanks again you two.   ill be seeing the ID MD soon and if i gather any knowledge beyond what is posted here ill surely update for future readers.

[leatherman]

ive always just felt like im in this on my own over the years

i felt the same way back in 1996 when I joined these forums when they were known as aidsmeds.com. All my friends had died, along with my first partner (I've lost two to HIV/AIDS; but was happily married a few yrs ago to my third longtime HIV+ partner) and I felt like I might have been the last HIV+ person in my area.

Know that many of us have traveled in the past the path that you do now and certainly understand. {{{hugs}}}

[TGun]

SO im back,, just received my lab results from this weeks draw in preperation for next weeks ID MD visit.  My CD4 count keeps dropping... Last years results were

11/20 - 873
4/21   - 711
7/21   -  533
11/21 -   486

Should i have reason to be worried??? Has anyone here gone through this fluctuation and what are the possible causes and can something be done??  I DID have a moderna covid vaccination also in Janauary of 2021,,, thats the only thing medically different for me this year, along with the annual FLU vaccine in October.

[leatherman]

you might want to look in your lab results at the cd4% numbers and compare those numbers. It's a more stable number and takes into account the cd8 number too. If there's little change in that percentage then there's nothing to worry about.

although in the end, since your cd4 count is a quantitative number instead of a qualitative number (a number of absolute amount not a number of strength/effectiveness) there's probably not much to worry about anyway.

Since cd4s can change by 100 pts a day, the change from 873 to 711 is nothing, just as the change from 533 to 486 is negligible. The change from 711 tp 533 is about 200pts; so all in all, your cd4 change doesn't seem to be too significant.

check on that cd4% number from these last 4 lab results and see what that is doing

[TGun]

Thanks Leatherman,,, heres my CD4% numbers from the last 4 lab tests,,, plese educate me if thats possible, as my appointment isnt for another 10 days and i dont want anxiety from now until then...

11/20 - 40
4/21  -  44
7/21  -  39
4/21  -  34

obviously the trend is downward of 6 points,,, thats all i know.. help please

[Jim Allen]

Hiya,

Sorry to hear this is stressing you. The stress can't helping your health.

Ill share my labs and how I feel about it. Maybe it will help, maybe it won't.

My last few CD4 counts were: 800 - 848 - 1140 - 670 and most recent 610. CD4 percentage all between 36 to 42%

Now as long as my VL remains suppressed and I'm nowhere near 14% or 200 count the CD4 is rather irrelevant If you ask me and my ID doc + every specialist I've ever met has expressed the same when CD4 counts were mentioned.

CD4's levels will fluctuate and it isn't a measurement of health.

[Jim Allen]

Both of us have CD4% that would be within normal range for the average HIV negative population 

https://i-base.info/qa/18

https://i-base.info/cd4-count/

[leatherman]

Now as long as my VL remains suppressed and I'm nowhere near 14% or 200 count the CD4 is rather irrelevant If you ask me and my ID doc + every specialist I've ever met has expressed the same when CD4 counts were mentioned.

CD4's levels will fluctuate and it isn't a measurement of health.

this is exactly how much to worry about your cd4s TGun - meaning, not at all Really, as long as you stay undetectable that's pretty much all there is to controlling HIV

omg y'all have nearly double the % that I've been living with for decades. Neither of y'all have anything to worry about with your cd4 counts. 

[Jim Allen]

omg y'all have nearly double the % that I've been living with for decades. Neither of y'all have anything to worry about with your cd4 counts. 

I would gladly share mine but unfortunately they are extremely lazy little fuckers.

[TGun]

you two are such a blessing,, thank you!!  I mentally felt alot better when i was farther away from 200 and slowly climbing over the years,, but this last year with the steady drop kinda go me worried... ill come back here with an update in a few weeks after seeing the ID to spread any info,, might help someone else at some point