Question
Why is my viral load fluctuating so much?
26 March 2010. Related: All topics, CD4 and viral load, Starting treatment.
I was diagnosed HIV positive in early 2007. The results of my CD4 counts and viral load (VL) tests so far are as follows:
CD4=700, VL=6,000
CD4=580, VL=7,000
CD4=900, VL=24,000
CD4=580, VL=240,000
These are from the first test up to the most recent one. The last two are the most recent tests taken three months apart. I am concerned about the huge difference between these two. I am especially concerned about the rise in VL from 24,000 to 240,000 in the space of three months. I just wonder if this is normal. Is it not supposed to be a steady increase?
This really scares me as my doctor is reluctant to start me on HIV medication as my CD4 seems to be okay. As far as I understand, the higher the VL, the higher the risk of sickness. Would it not be better in this case to start treatment irrespective of the CD4 count? I am trying to be sensible and keep going for tests but looking at this, I am scared I am going to get sick anyway because the CD4 is blocking me from starting treatment.
Answer
Thank you for your question.
Please don’t be scared. When to start treatment is a big decision and it is great that you are actively seeking the information you need to make that decision.
You should speak to your doctor about a confirmatory test. It is important that you continue to monitor your CD4 and viral load results over the next few months to see what happens.
There are several possible reasons for your sudden increase in viral load. Firstly there could be an additional underlying infection. Secondly it could just be a viral load ‘blip’ which is where a sudden increase in viral load is seen and then it goes back down again. Unfortunately we do not yet know what causes this.
Finally it is possible that there was a mistake made with your lab results. The viral load test first multiplies the amount of virus found in the blood so that it can be counted. This means mistakes are easy to make. There is a 3-fold margin of error with viral load test which means that your results of 240,000 could be anywhere between 80,000 and 720,000copies/ml.
It is not usually the case that the higher the viral load the higher the risk of sickness. It is more the lower the CD4 the higher the risk of sickness as the CD4 count is measuring the state of your immune system. If the CD4 count is low then your immune system is also low and you are more likely to get sick. A CD4 count of 580 is still very good.
When to start treatment is your decision to be made in consultation with your doctor. You should not feel that anything is a barrier to your starting treatment.
If you are thinking of starting treatment you may find it useful to read the i-Base ‘Introduction to Combination Therapy’ guide.
My VL last month was 6900 they gave me three months and I tested again than its 7900 and they I must change the treatment and I don’t want to change the because am already in line two is there any chance to go down if I am true to myself and eat my treatment very well
Hi Joyce,
Taking your meds late won’t have any impact on your viral load. There’s the possibility that this could be a ;ab error. Are you in a position to have your viral load retested?
Hi my viral load has been undected all along but now it is more than 200 copies what is the reason for increase yet l take medication daily l however at times take medication late by an hour and recently l had a flu that lasted about 2 weeks . I always have protected sex
Hi Jason, if you have been taking all you meds as prescribed this is likely to just be either a blip or a test error. In the UK this should still be confirmed by a second test though. This guide has more information.
http://i-base.info/guides/changing
Hi
I have been on meds for 3 years now and after 3 months had an undetectable viral load.
My recent test has come back as cd4 = 694 (this has gone up from last test) though viral load was recorded as 90.
I rang clinic and they said nothing to worry about….. can this be Ok?
Hi Thembi,
Can I just confirm. You’ve been on ARVs for 7 months and your viral load isn’t decreasing, is this correct?
Hi ive been on a treatment for 7 mounths my my varal load dont increanse im doing every thing to fight for my welleness plz help if u knw somthing dat can help me
Hi Thulile,
For me to be able to answer your question, I need some more info.
When did you begin meds? What was your viral load when you started? What is it now?
If you’ve just started, then the following link may be of some help:
https://i-base.info/qa/4669
Hi then m on HIV treatment but have problem of high viral load
Hi there,
One of the reasons for not starting treatment is down to the fact that once you start, you go down a road of possible side effects.
I was in hospital last year undiagnosed because my GP didn’t think it could be HIV. I had a CD4 count of just 10. I had pneumonia (PCP) – which essentially meant I had AIDS. I was in for just over 2 weeks, undergoing treatments and being monitored every hour as the chances of me pulling through were very slim.
But I did pull through.
Since March 09, when I was admitted, I have battled back from being 9st in weight, a CD4 of 10 to today, where my CD4 is 365 and I weight in at 14st and most of it muscle.
However, after just a year on Atripla, I have now become resistant and am undergoing tests on other combinations. Although there are a lot, most don’t work on me so I am in ‘no mans land’ again.
You must stay positive, challenge your doctors if you feel you need to, eat a healthy diet and you can get through this most challenging time in your life.