Q and A

Question

Is this a viral load blip?

I have been on Combivir and Kaletra since November 2012 and my last results in March was as follows:

CD4 – 394
VL – undetectable

Another routine test for CD4 and VL was carried out in May and results in June came as follows:

CD4 – 561
VL – 116

Yesterday I had an appointment with my ID doctor and he said that most probably this could be a blip.

Is this really a blip? Do blips happen so soon after a couple of months on treatment?

Way back in 2012 I was on Combivir and Sustiva and this pattern happened again. Became UD after a couple of months, then VL started going up – first test 69, second test 175 … Doctor decided to change treatment at that time and put me on Kaletra but it seems that this is happening again.

Kindly advise.

Answer

Hi,

Thanks for your email. The definition of a ‘viral load blip’ is usually one detectable viral load test result- between 50 and 1000- which is preceded and followed by an undetectable viral load.

If you were in the UK you would have your viral load re-tested the day you received this detectable result. If this is a blip your viral load would be undetectable on this confirmatory test. If the viral load was still above 50 then it is likely this would be a real viral load rebound. Did your doctor take more blood to do a re-test when you got this result?

If your viral load is rebounding it is important that your doctor changes all of your HIV drugs. It is possible that you could have some resistance to the drugs in combivir and this is the reason why your viral load is not being controlled by either combination that you mentioned. But it’s important to get a confirmation viral load test before getting too worried or making any change in treatment.

Please see this page about viral load blips for more information.

6 comments

  1. Roy Trevelion

    Hi Magdeline,

    I’m sorry to hear your daughter is in hospital. Did the doctor explain why she had to go in? Is it because of her skin condition, she could ask how it can be treated.

    But it would help her to know what her viral load results are. It could be just been a blip, please see above. Or it could be because her medication is not working well and HIV has rebounded.

    She could ask for a resistance test to see if she needs to change to different HIV meds. And if there is viral rebound, please see the guide to changing treatment.

    If you live in South Africa here is the link to the Treatment Action Campaign. They might be able to help with local support.

    Please let us know the results of her viral load and CD4 count tests. What HIV meds is she taking at the moment?

  2. Magdeline

    my daughter has be diagnosed with HIV in 2011 she was on medication since them but what worries me is her viral load has gone up she is now in hospital and the colour of her skin has changed to bitch black (charcoal) is there anything we can do to remove the marks and also reduce her viral load. I am not clued up with HIV related medication

  3. Simon Collins

    Hi – I am sorry it has taken longer to approve and reply to your comment. Please could you let me know if you still need an answer? In the UK if viral load continued to be detectable, then a doctor would normally recommend changing treatment. This depends on the drugs that are available in your country though which can vary. If there are not alternative options to Kaletra and your viral load is still in the low hundreds, then you could consider changing the Combivir to a different dual-NRTI combination, perhaps using tenofovir+FTC or abacavir+3TC.

    It seems good advice to get your viral load back to undetectable, and to keep it there for a few months before trying for a baby as this would be likely to reduce the risk to your partner.

  4. SE

    Dear Ms McDowall,

    I was re-tested in June however it seems like I had another re-bound in numbers since the test came back as 242 (viral load). Prior this test, I spoke with my ID doctor regarding my previous result and I was informed that since my CD4 number increased, there was no indication that the treatment was failing.

    Now that my VL went up again, even though in small numbers, I am really worried that the meds, currently on Combivir and Kaletra are not working as they should to keep the viral load at bay.

    Another major factor I am concerned of is that my wife and I want to have a baby and want to try to conceive naturally and since I am having these re-bounds we cannot proceed any further. Doctor informed us that if the current result will be under 200, we can still proceed using PREP but he advised that if the viral load if above 200, we’d rather wait.

    What’s your advice, please?

  5. Rebecca McDowall

    Hi SE,
    Yes, it is a good idea to speak to your doctor and try to get a re-test sooner than this. If your viral load is rebounding it is important to know this now so that you can look at adherence or change treatment to get this under control.

  6. SE

    My doctor informed me that he would test me again in 2 months time. He never mentioned to re-test on the same day when I received the test were my viral load was detectable.

    Should I bring this up and check whether it is possible to re test prior the 2 month period?

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