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Author Topic: Positive viral load below limits of quantification  (Read 1807 times)

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Offline aupointillimite

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Positive viral load below limits of quantification
« on: November 22, 2019, 09:33:17 am »
Hello all!

I have some questions about a couple recent viral load tests I've had.

Background: I've been HIV+ since 2005. I was on Atripla from about 2006 to 2014 when I switched to Triumeq. I've had no real problems for years with either regimen.

For six months now, I'm not getting undetectable viral loads. I've gotten two positive results that are "below the limit of quantification." I've had blips before. Previous docs have said that this was no big deal, that it was a result of extremely sensitive PCR testing, etc. They always went back to undetectable on the next test.

But now I have a new doc who seems less than pleased about blips. I've tried to see if this could be a warning of virologic failure, but I haven't been able to find anything concrete on this.

If anyone here has any insights, I'd really appreciate hearing them. Thank you!
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Offline Jim Allen

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Re: Positive viral load below limits of quantification
« Reply #1 on: November 22, 2019, 09:59:06 am »
Hiya,

 :o Sorry but your new doctor sounds wet behind the ears if they are worried about "below the limit of quantification." So how low does their test go? 20 copies / 50 copies?

Plenty on this topic BTW, I've included a few links below to help but "below the limit of quantification." is not even a blip unless they are using an older test with the limits at a few hundred copies.

Jim

3 page decent (I think) Q&A on this topic that might help.- They should read this one.

Paul E. Sax, MD, clinical director of the HIV program and the division of infectious diseases at Brigham and Women’s Hospital in Boston

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

Low-level blips & treatment

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

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 500–999 copies/mL were associated with virologic rebound, whereas blips of 50–499 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.

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/

Blips

http://i-base.info/guides/changing/viral-load-blips
« Last Edit: November 22, 2019, 10:05:48 am by Jim Allen »
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Offline Jim Allen

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Re: Positive viral load below limits of quantification
« Reply #2 on: November 22, 2019, 10:08:41 am »
BTW How are you doing/feeling?

Hope things are going well.

Best, Jim
HIV 101 - Everything you need to know
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Transmission and Risks:
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Offline aupointillimite

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Re: Positive viral load below limits of quantification
« Reply #3 on: November 22, 2019, 10:53:56 am »
Thank you so much! I don't know what the lower limit of quantification on their test is. I go to a university medical center that does a lot of research, so I'm going to assume it's 20.

I'm feeling completely fine otherwise! I've never had any issues with HIV after nearly fifteen years. CD4s all up in the 700 - 900 range. I have good med adherence, which probably helps.

I really appreciate the resources- I'll check them out in case the new doc starts freaking out on me.  :)
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Offline Jim Allen

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Re: Positive viral load below limits of quantification
« Reply #4 on: November 22, 2019, 11:45:14 am »
Hiya,

Glad to hear you are feeling fine, it's one of the things that matter the most. 
Yeah, I would also assume it's a 20 limit and hopefully, your doc will learn to keep their drama to themselves, if you need more references just let me know.

Best, Jim
HIV 101 - Everything you need to know
HIV 101
Transmission and Risks:
HIV Transmission and Risks
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline Expat1

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Re: Positive viral load below limits of quantification
« Reply #5 on: November 23, 2019, 03:29:57 pm »

But now I have a new doc who seems less than pleased about blips. I've tried to see if this could be a warning of virologic failure, but I haven't been able to find anything concrete on this.

I think blips are at the VL 200+ level.

Detectable less than level of Detection is still considered Undetectable.  It could be 1 or 5.  ETC.  I would replace the doctor before I would replace the medicine. 

Offline BlueMoon

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Re: Positive viral load below limits of quantification
« Reply #6 on: November 26, 2019, 11:30:03 am »

If anyone here has any insights, I'd really appreciate hearing them. Thank you!

You do not quantify these "blips" so it is hard to have an opinion about them.  However, bear in mind that the term "undetectable" refers to a limit on testing precision and is not necessarily a measure of virologic success or failure. 
It's a complex world

 


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