Q and A

Question

Will changing from TLE to TLD effect my viral load?

I am male 33, diagnosed in 2012 and began treatment in 2013. Been on TLE from 2014 until I was moved to TLD in 2021. My Viral load is checked annually each January, and since January 2015 to January 2021 my VL has been undetectable. I was then moved to TLD in March 2021, at the same time I was diagnosed with hypertension and was put on Hydrochlorothiazide and Amlodipine. In January 2022 my VL results came back 115copies/ml. I have been in an exclusively monogamous relationship for the past 10 years, so I don’t think being reinfected with another strain of the virus would be the reason behind the spike.

Could the change in regiment be the cause of the VL spike? I understand 115 wouldn’t sound so bad, but having been undetectable for the longest while, it does rattle me psychologically.

Answer

Hi Roland, how are you doing?

There are a number of reasons why you may have a spike in your viral load. Switching classes of HIV medication is the least likely.

This is also not considered a significant increase.

Your hypertension medicine does not interact with TLD. There is no risk of this being the cause of this blip.

Switching from TLE to TLD is very common and does not risk a rebound. As you were undetectable before switching, resistance would not develop. This new combination would be just as effective at suppressing your viral load. How are you finding this new combination? Often people tolerate TLD much better than TLE.

When you last had your viral load test did you recently have a vaccine or were ill? Both of these factors can temporally increase your viral load and this will soon return to being undetectable. Occasional blips do also occur with no reason and these also will return.

A further reason could be a lab error – these most often account for viral load changes, but as yours is still so low this would not be a cause of concern. There is also the possibility of a change of test. When newer tests are used they can be more specific. In this case your viral load always being around 100 but only this new test could give a specific value.

Are you still taking your medication everyday?

Below 200 you are still considered undetectable and U=U can still apply.

Josh.

5 comments

  1. Josh Peasegood

    Hi Innocent, how much weight have you lost? and how long after switching did you notice this weight loss?

    In most cases people find they gain weight when being switched from TLE to TLD. Has anything else in your life changed that could have caused this weight loss e.g., increased activity/exercise, stress or eating less?

    Alongside this weight loss have you noticed any other symptoms like recurrent fevers or night sweats?

  2. Innocent

    They have switched me from TLE to TLD and I’m loosing weight so much.is it possible for me to switch back to TLE

  3. Josh Peasegood

    Hi Violet, I am sorry to hear that you have been feeling weak. How long have you been feeling like this?

    What time of the day are you taking your medication? and are you sleeping well?

    When you had this test done were you feeling well? Sometimes viral load can go up if you have been ill or recently had a vaccine. It can also be a random error/blip. Have you been offered a second test to confirm the result?

  4. Violet

    Hi Dr I’m changeed from Tee to Tld but my viral laid is high from 224 msy to 655 October and I’m starting to feel weak

  5. Roland

    Hi Josh
    Thank you so much for the response. It really makes sense. I had my second COVID vaccine (Comirnaty) about seven weeks prior to my last VL test which was in January 2022. I think that might be a reason behind the spike.
    Thanks again

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