Question
After six months on meds, why is my viral load still over 15,000?
15 March 2017. Related: Adherence, All topics, CD4 and viral load, Changing treatment, Resistance.
Hi, I live in Nigeria and I first tested positive in 2011.
I waited till January 2016 before starting treatment (this was a personal decision).
My baseline CD4 count was 338 (viral load test was not done). So I started treatment and 6 months later I went for a follow up and was told that now only viral load was done without the CD4. The result was 15300 viral load.
I had been adherent till that point and didn’t know why. It was really depressing and I started defaulting after then. I had another test done yesterday and my doctor was obviously furious. He seems to think I would have to be moved to second line of treatment depending on what my test result shows.
My question really is how is it that my viral load showed 15300 after 6 months of being adherent?
Answer
Thanks for getting in touch.
Both the US and UK guidelines say that viral load should be undetectable within three months. However, sometimes this takes longer, especially if viral load is very high (over 100,000 copies/mL).
For more see here:
https://i-base.info/qa/4669
Although it is annoying that the viral load was tested before, as your CD4 count was still pretty good, viral load is unlikely to have been very high.
Also, as you have been adherent (i.e. not missing doses) you may just have been unlucky and have had drug resistance to one of your meds before you started treatment. This would have mean that only one or two drugs were active, even though you were taking a full combination.
Depending on where you live, up to 10% or even 20% of people who have not used treatment, have some drug resistance before then start. So you have just been unlucky. It is sometimes easier for doctors to blame their patient for not taking meds, but if you had drug resistance without realising this, there is nothing else you could do.
If the latest results still have a similar viral load, then your doctor is right that you need second-line treatment. Ask whether a resistance test is available, though this is less likely.
If you start second-line treatment, please go back to very good adherence. The next treatment is then likely to get your viral load to undetectable.
Hi Dare,
You’re welcome.
Where are you in Nigeria? And is it possible to change were you get your care?
Thank you Lisa.
I am currently taking Tenofovir/Lamivudine/Efavirenz. I asked for a CD4 test, but the doctor said the new regulation was that only viral load tests are done. Apparently, most HIV medical personnel in Nigeria think they’re doing you a great favour by even helping you get treated and they cannot be disturbed.
I really doubt that he’d agree to have me do a resistance test. I don’t even know if it’s done in Nigeria. I have an appointment in June, will ask him about it then.
Thank you again.